Costs and Effects of Secondary Prevention with Perindopril in Stable Coronary Heart Disease in Poland
- 1 January 2008
- journal article
- Published by Springer Science and Business Media LLC in PharmacoEconomics
- Vol. 26 (10), 861-877
- https://doi.org/10.2165/00019053-200826100-00006
Abstract
Objectives: To estimate the long-term impact of treatment with perindopril on costs and health effects in patients with stable coronary artery disease in Poland. Methods: The cost-effectiveness analysis was based on data from a randomized double-blind, placebo-controlled trial. A decision-tree analysis was employed, including Monte Carlo and bootstrapping techniques. This study was a sub-study of the EUROPA (European Trial on Reduction of Cardiac Events with Perindopril in Stable Coronary Artery Disease) trial (n = 12 218; mean follow-up 4.2 years). Resource use was based on data from Polish EUROPA study patients (n = 1251), while effectiveness was based on the whole EUROPA study. The health gain of perindopril in life-years was based on overall EUROPA study results, and the adapted Polish life expectancy of patients not dying during the trial. Costs were calculated in new Polish zloty (PLN), year 2003 values; €1 = PLN4.053. Only direct healthcare costs related to cardiovascular events and medication use were studied. Results: When observed mortality was combined with life expectancy beyond the end of the study, perindopril use showed a gain in life expectancy of 0.182 lifeyears (SD ± 0.129) at a cost of PLN1983 (SD ± 103) with discounting of 5% per annum on costs and no discounting on effects. This resulted in an incremental cost-effectiveness ratio (ICER) of PLN10 896 per life-year gained. The probability that the ICER for perindopril was below the threshold of PLN60 000 was 88%. The overall results were insensitive to discount rates for costs and life-years. Conclusions: Perindopril leads to a reduction in the risk of coronary events among patients with stable heart disease. When the expected improvement in life expectancy is combined with associated medical costs, there is a high probability that perindopril is cost effective, given the threshold of PLN60 000 per life-year gained.Keywords
This publication has 14 references indexed in Scilit:
- Cost effectiveness of perindopril in reducing cardiovascular events in patients with stable coronary artery disease using data from the EUROPA studyHeart, 2007
- Conducting economic evaluations alongside multinational clinical trials: Toward a research consensusAmerican Heart Journal, 2005
- Assessing the appropriateness of combining economic data from multinational clinical trialsStatistics in Medicine, 2003
- Cost Implications of the Use of Ramipril in High-Risk Patients Based on the Heart Outcomes Prevention Evaluation (HOPE) StudyCell Metabolism, 2003
- Handling Uncertainty in Cost-Effectiveness ModelsPharmacoEconomics, 2000
- Effects of an Angiotensin-Converting–Enzyme Inhibitor, Ramipril, on Cardiovascular Events in High-Risk PatientsNew England Journal of Medicine, 2000
- Confidence intervals or surfaces? Uncertainty on the cost-effectiveness planeHealth Economics, 1998
- Effects of captopril on ischemic events after myocardial infarction. Results of the Survival and Ventricular Enlargement trial. SAVE Investigators.Cell Metabolism, 1994
- Costs, effects and C/E‐ratios alongside a clinical trialHealth Economics, 1994
- Effect of enalapril on myocardial infarction and unstable angina in patients with low ejection fractionsThe Lancet, 1992