PharmacoEconomics

, Volume 3, Issue 5, pp 387–397 | Cite as

Effects of ACE Inhibitors on Heart Failure in The Netherlands

A Pharmacoeconomic Model
  • Ben A. van Hour
  • Gina Wielink
  • Gouke J. Bonsel
  • Frans F. H. Rutten
Original Research Article Cost Effectiveness of ACE Inhibitors

Abstract

Summary

A modelling approach is uscd to analyse the cost effectiveness of prescribing angiotensin converting enzyme (ACE) inhibitors, compared with standard practice, as first-line therapeutic agents in the treatment of hean failure in The Netherlands. Data concerning costs, incidence. prevalence and survival are used to construct an age-dependent semi-Markov-chain model. Two scenarios are compared. The first reflects the continuation of common practice. The second. containing assumptions made on the basis of results from randomised clinical trials, reflects the situation in which ACE inhibitors are given as first-lin e pharmacotherapy. Conditional on the esti mates and assumptions made. it is shown that prescribing ACE inhibitors as first-tine pharmacotherapy will improve survival by about 4% over the first 10 years. and will save about 17% in costs over the first 10 years. Sensiti vity analysis shows the robustness of the conclusio ns to all major parameters.

Keywords

Heart Failure Dutch Guilder Dutch Male Hean Failure Multicenter Research Group 

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References

  1. Captopril Multicenter Research Group. A placebo-controlled trial of Captopril in refractoly chronic congestive heart faillire. Journal of the American College of Cardioqy 63: 755–763, 1983Google Scholar
  2. Captopril-Digoxin Multicenter Research Group. Comparative effects of therapy with caplopriland dilOain in patients with mild to moderate heart failure. Journal oftht American Medial Aswciation 259: 519–544, 1988Google Scholar
  3. Chatterjee K, Parmley WP, Colin JN, Levine TB, Awan NA, et al. (Captopril Multicenter Research Group I). A cooperative multicenter study of C1lptopril in Congestivet heart failure: hemodynamic effects and long-term rnponse. American Heart Journal 110: 439–441, 1985PubMedCrossRefGoogle Scholar
  4. Cleland JGF. ACE-inhibitors in mild heart failure: first-line or second-line therapy? European Heart Journal 11: 53–57, 1990PubMedCrossRefGoogle Scholar
  5. Cohn IN, Archibald DG, Zinche S, Franciosa JA, Hartson WE, et al. Effcts of vasodilator therapy on mortality in chronic congestive heart failure. New England Journal of Medicine: 314: 1547–1552, 1986PubMedCrossRefGoogle Scholar
  6. Cohn IN, Rector TS. ProsnOsis or congestive titan faillln: and prediclon of mortality. American Journal ofCaroiolOgy 62: 25A–30A, 1988PubMedCrossRefGoogle Scholar
  7. Cotln IN, Jotlnson G, Ziesctle S, Cobb F, Francis G, et al. A compariwn of enllapril with hydralazineisorbic: le din ilrale in the tratment of ctlronic congestivc heart failure. New England Journal of Medicine 325: 303–310, 1991CrossRefGoogle Scholar
  8. Consensus (Cooperative Nonh Scandinavian Enalapril Slirvival Study). Effects of enalapril on monality in seven: congestive heart failure. New England Journal of Medicine 316: 1429–1435, 1987CrossRefGoogle Scholar
  9. Franciosa JA, Wilen M, Ziesche S, Cohn IN. Survival in men with severe chronic left ventricular failure due to either roronary titan disease or idiopathic dilated cardiomyopathy. American Journal of Cardiology 51: 831–836, 1983PubMedCrossRefGoogle Scholar
  10. Kannel WB. Epidemioloay find prevention of cflrdiac failure: Framingham study in sights. European Hean Journal 8: 23–29, 1987CrossRefGoogle Scholar
  11. Kannel WB, Plehn JF, Cupples LA. Cardiac faillire and sudden death in tlw: — framingham Study. American Heart Journal 115: 869–875, 1988PubMedCrossRefGoogle Scholar
  12. Kannel WO. Epidcmiological aspects of heart failure. CardiolOgy Clinics 7: 1–9, 1989PubMedGoogle Scholar
  13. Koopmanschap MA, Roijen L, van Bonneux L. Kosltn va n lieklen in Nederland. Report of the Depanmcnt of Public Health and Social Medicine and the Institute for Medical Tectlnoiosy Assessment, Erasmus University Rotterdam. Rollmam, 1991Google Scholar
  14. Koopmanschap MA, van Ineveld BM. Towards a new approach for Hlimalinl indirect costs of disease. Social Sciece and and Medicine 34: 100S–1010, 1992Google Scholar
  15. McFate Smith W. Epidiomiology of ronaestive hurt failure. American Journal of Cardioipsy 55: 3A–8A, 1985CrossRefGoogle Scholar
  16. Parmley WW. PathophysiololY and Current therapy of conscstivc hnrt failure. Journal of the American College for Cardiology 13: 771–785, 1989CrossRefGoogle Scholar
  17. Poole-WilsOn PA. Future persptctives in the managemen t of congestive Man failure. American Journal of Cardiology 60: 462–467, 1990CrossRefGoogle Scholar
  18. Remcs J, Miettinen H, Rellnantent A, Pyorala K. Validity of clinical diagnosis of heart failure in primary health care. European Hcan JOurnal 12: 315–321, 1991Google Scholar
  19. SOLVD-investigators. Effect of Enalapril on survival in patients with redllccd left ventriclil ar ejection frictions and conscstive heart failuft. New England Journal of Medicine 325: 293–302, 1991CrossRefGoogle Scholar
  20. van der Velden J. Nationale studie van tick ten en verrichlintcn en de tluisaruenpr1lklijk. Mtdiseh Contact 45: 60–74, 1990Google Scholar
  21. Wilson JR. Prosn0sis in severe heart failure: relation to hemodynamic measurements and venlricular ectopic activity. Journal of the American College of Cardiogy 2: 403–441, 1983CrossRefGoogle Scholar

Copyright information

© Adis International Limited 1993

Authors and Affiliations

  • Ben A. van Hour
    • 1
  • Gina Wielink
    • 1
  • Gouke J. Bonsel
    • 1
  • Frans F. H. Rutten
    • 1
  1. 1.Institute for Medical Technology AssessmentErasmus UniversityRotterdamThe Netherlands

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