Inspra (eplerenone) has now been accepted by the All Wales Medicines Strategy Group (AWMSG) for use in adult patients with chronic heart failure (CHF) NYHA class II, in combination with standard optimal therapy, (1) following evidence to support its effectiveness in reducing the risk of hospitalisation and death. (2)
Almost one in every 100 people in Wales has chronic heart failure,(3) a form of cardiovascular disease associated with a high mortality rate with 75% of people dying within five years of their first hospitalisation for the disease.(4) Cardiovascular disease remains Wales’ biggest killer accounting for nearly 35% of all premature deaths. (3) Furthermore, approximately 45,000 people aged 45 years and over have heart failure in Wales.(5)
“The inclusion of eplerenone into the AWMSG guidelines is good news for patients as ensuring those with heart failure receive the most effective treatments can have a real impact on outcome,” said Professor Julian Halcox, Professor of Cardiology, Cardiff University School of Medicine. “Heart failure is the only major cardiovascular disease that continues to increase in incidence and prevalence. We have made significant progress in reducing the burden of heart disease in Wales but we must continue to improve where we can for these patients. While the NICE guidelines on the treatment of this condition are not due to be reviewed for some time, the recent decision by the AWMSG to accept eplerenone will make a valuable additional contribution toward the care of patients with this progressive and life-threatening disease.”
Chronic heart failure accounts for around 2% of total healthcare expenditure in developed countries, with up to 70% of these costs due to hospitalisation.(6, 7) Hospitalisation due to heart failure is commonplace and these hospital admissions last an average of 11 days.(8) In addition, every heart failure emergency admission costs at least £1,638.90.(9) As such, heart failure places a significant burden on healthcare budgets – a particular concern at times of increased financial pressure on healthcare spending.
Eplerenone has been shown to reduce the risk of cardiovascular death or heart failure hospitalisation by 37%.
The AWMSG’s advice on eplerenone is in line with the recent update made by cardiovascular disease experts of the European Society of Cardiology (ESC) in their guidelines for chronic heart failure and the advice issued by the Scottish Medicines Consortium (SMC) in July.
(1) All Wales Medicines Strategy Group. AWMSG advice. Data on file.
(2) Zannad F, et al; the EMPHASIS-HF Study Group: Eplerenone in Patients with Systolic Heart Failure and Mild Symptoms. New England Journal of Medicine 2011; 364:11-21.
(3) British Heart Foundation Health Promotion Research Group, Department of Public Health. Coronary heart disease statistics. University of Oxford. 2010 edition.
(4) Stewart S, et al. More 'malignant' than cancer? Five-year survival following a first admission for heart failure. European Journal of Heart Failure. 2001 Jun;3(3):315-22.
(5)The cardiac disease National Service Framework for Wales. 2009.
(6) McMurray J, et al. The pharmacoeconomics of ACE inhibitors in chronic heart failure. Pharmacoeconomics 1996;9(3):188-197.
(7) Stewart S, et al. The current cost of heart failure to the National Health Service in the UK. European Journal of Heart Failure. 2002 Jun;4(3):361-71.
(8) NICOR: National Institute for Cardiovascular Outcomes Research. National Heart Failure Audit: April 2010 – March 2011. UCL, 2012.
(9) National Schedule of Reference Costs Year '2009-10' - NHS Trusts HRG Data.