Real-world eligibility and cost-effectiveness of finerenone in heart failure: insights from the Korean heart failure III (KorHF III) registry
M Kim, J Lee, J Oh, C J Lee, S M KangAbstract
Background
Finerenone, a selective non-steroidal mineralocorticoid receptor antagonist, has demonstrated cardiorenal benefits in key clinical trials. This study evaluated real-world eligibility for finerenone among Korean heart failure (HF) patients and assessed its long-term cost-effectiveness from the perspective of a national healthcare payer.
Methods
Using data from the nationwide Korean Heart Failure III (KorHF III) registry, we assessed finerenone eligibility by applying both the FINEARTS-HF (Finerenone Trial to Investigate Efficacy and Safety Superior to Placebo in Patients With Heart Failure) criteria and the Food and Drug Administration / European Medicines Agency (FDA/EMA) label. Baseline characteristics and clinical outcomes were compared between eligibility groups. A state-transition Markov model, adapted from the FINE-CKD model, was developed to evaluate the long-term cost-effectiveness of finerenone plus standard of care (SoC) versus SoC alone.
Results
Among 7,186 patients discharged alive, 16.1% met the full FINEARTS-HF criteria whereas only 4.3% fulfilled the FDA/EMA label. Patients eligible under the regulatory label exhibited a higher burden of prior HF hospitalization, elevated N-terminal pro-B-type natriuretic peptide levels, and significantly worse 12-month outcomes compared with those meeting the trial criteria. In the base-case economic analysis, finerenone plus SoC yielded incremental gains of 0.33 quality-adjusted life years (QALYs) at an additional cost of 4.9 million Korean won (₩) ($3,500). This resulted in an incremental cost-effectiveness ratio of ₩14.8 million ($10,500) per QALY, which is well below the willingness-to-pay threshold. Probabilistic sensitivity analysis indicated a 90.4% likelihood of finerenone being cost-effective at this threshold.
Conclusions
Real-world eligibility for finerenone varies substantially depending on the criteria applied, identifying clinically distinct risk profiles. From the Korean healthcare payer’s perspective, the addition of finerenone to SoC was highly cost-effective under the current economic assumptions, potentially reducing the long-term clinical and economic burden of cardiorenal complications.Flow chart of patient selectionFor image description, please refer to the figure legend and surrounding text.Incremental cost-effectiveness planeFor image description, please refer to the figure legend and surrounding text.