« Back to Farmacia Journal 3/2026

COST-EFFECTIVENESS ANALYSIS OF ESAXERENONE IN RESISTANT HYPERTENSION MANAGEMENT: A PARTITIONED SURVIVAL HEALTH ECONOMIC MODEL

DIMITRIJE GRBIC ^1,2*, SLOBODAN JANKOVIC ³

Download Full Article PDF

This is the cost-effectiveness study of esaxerenone in patients with resistant hypertension (RH). The partitioned-survival model compared esaxerenone, spironolactone, eplerenone, finerenone, and baxdrostat. Health states were uncomplicated RH, RH with non-fatal complications, and death. Inputs were sourced from the literature. Intervention costs were referenced from the Republic Fund of Health Insurance of Serbia (RSD). Quality-Adjusted Life Years (QALY) were calculated using the EQ-5D. Treatment benefits are reflected through better blood pressure control. Analysis was from a third-party payer perspective with 3-month cycles, a 10-year modeling period, and an annual 5% discount. The outcomes were the incremental cost-effectiveness ratio (ICER) and net monetary benefit (NMB). The willingness-to-pay was 4,393,536 RSD/QALY. Sensitivity analyses assessed robustness. The results showed that esaxerenone was dominant in the base-case scenario. Spironolactone, eplerenone, and finerenone were more effective than baxdrostat. Spironolactone and finerenone dominated eplerenone. Spironolactone yielded cost savings versus finerenone but also had lower effectiveness (-85,810 RSD cost increment, -0.0066 QALY increment, and 56,890 RSD NMB at 10-year endpoint). Sensitivity analyses demonstrated stable findings, except for spironolactone versus finerenone and esaxerenone comparisons (which significantly relied on extrapolated effectiveness).