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PharmacoEconomics

, Volume 12, Issue 2, pp 182–192 | Cite as

An Economic Analysis of the Survival and Ventricular Enlargement (SAVE) Study

Application to the United Kingdom
  • Sylvia Hummel
  • James Piercy
  • Robert Wright
  • Andrew Davie
  • Adrian Bagust
  • John McMurray
Original Research Article

Summary

Recent studies have shown that ACE inhibitors reduce morbidity and mortality after myocardial infarction (MI). While these trials have obvious clinical implications, the widespread introduction of a new treatment for a condition as common as MI also has clear cost implications.

The results of the post-MI studies with ACE inhibitors suggest that restricted use of treatment — in high-risk patients — is likely to be most cost effective, whereas treatment of all MI survivors, many of whom are at low risk, will be least cost effective. An approach somewhere in between may maximise clinical benefit at an acceptable cost. Economic analysis may help in deciding how these drugs might be best used after MI. We have conducted a cost-effectiveness and cost-utility analysis of the Survival and Ventricular Enlargement (SAVE) study, which reported the benefit of ACE inhibitors in intermediate-risk patients.

Assuming all MI survivors require measurement of left ventricular function before selection for treatment (the approach used in the SAVE study), the incremental cost per life-year gained (LYG), over 4 years, using prophylactic captopril is approximately 10 000 pounds sterling (£) [1994 to 1995 values]. The cost per quality-adjusted life-year (QALY) is similar.

These incremental cost per LYG and cost per QALY ratios compare favourably with other commonly used symptomatic and prophylactic treatments, and argue for extending post-MI use of ACE inhibitors to intermediate- as well as high-risk patients.

Keywords

Adis International Limited Left Ventricular Ejection Fraction Coronary Artery Bypass Grafting Captopril National Health Service 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Department of Health and National Health Service (NHS) Management Executive. Assessing the options: CHD/Stroke. Target: effectiveness and cost-effectiveness of interventions to reduce CHD and stroke mortality. London: UK Department of Health and NHS; 1995 Feb. Document no.: F50/076 2004 1P I0KGoogle Scholar
  2. 2.
    Jönsson B. Cost-effectiveness: a new criterion for selecting therapy. J Intern Med 1995; 237: 1–3PubMedCrossRefGoogle Scholar
  3. 3.
    Freemantle N, Henry D, Maynard A, et al. Promoting cost-effective prescribing. BMJ 1995; 310: 955–6PubMedCrossRefGoogle Scholar
  4. 4.
    van Hout BA, Wielink G, Bonsel GJ, et al. Heart failure and ACE inhibitors on heart failure in the Netherlands. Pharmacoeconomics 1993, 3(5): 387–97PubMedCrossRefGoogle Scholar
  5. 5.
    Paul SD, Kuntz KM, Eagle KA, et al. Costs and effectiveness of angiotensin converting enzyme inhibition in patients with congestive heart failure. Arch Intern Med 1994, 154: 1143–9PubMedCrossRefGoogle Scholar
  6. 6.
    Hart W, Rhodes G, McMurray JJV. The cost effectiveness of enalapril in the treatment of chronic heart failure. Br J Med Econ 1993; 6: 91–8Google Scholar
  7. 7.
    The Acute Infarction Ramipril Efficacy (AIRE) Study Investigators. Effect of ramipril on mortality and morbidity of survivors of acute myocardial infarction with clinical evidence of heart failure. Lancet 1993; 342: 821–8Google Scholar
  8. 8.
    Pfeffer MA, Braunwald E, Moyé LA, et al. Effect of captopril on mortality and morbidity in patients with left ventricular dysfunction after myocardial infarction. N Engl J Med 1992; 327: 669–77PubMedCrossRefGoogle Scholar
  9. 9.
    Gruppo Italiano per lo Studio della Sopravvivenza nell’Infarto Miocardico. GISSI-3: effects of lisinopril and transdermal glyceryl trinitrate singly and together on 6 weeks mortality and ventricular function after acute myocardial infarction. Lancet 1994; 343: 1115–22Google Scholar
  10. 10.
    ISIS Collaborative Group. A randomised factorial trial assessing early oral captopril, oral mononitrate and intravenous magnesium sulphate in 58,050 patients with suspected acute myocardial infarction. Lancet 1994; 345: 669–85Google Scholar
  11. 11.
    Rutherford JD, Pfeffer MA, Moyé LA, et al. Effects of captopril on ischaemic events after myocardial infarction. Circulation 1994; 90: 1731–8PubMedCrossRefGoogle Scholar
  12. 12.
    Piercy J, Phillips Z. Costing of cardiology services in the United Kingdom. York: York Health Economics Consortium, 1995Google Scholar
  13. 13.
    Isard PA, Forbes JF. The cost of stroke to the National Health Service in Scotland. Cerebrovasc Dis 1992; 2: P47–59CrossRefGoogle Scholar
  14. 14.
    National Health Service (NHS) drug tariff. London: HMSO; 1994 MayGoogle Scholar
  15. 15.
    British National Formulary No. 27. London: British Medical Association and the Royal Pharmaceutical Society of Great Britain, 1994Google Scholar
  16. 16.
    Parsonage M, Neuberger H. Discounting and health benefits. Health Econ 1992; 1: 71–6PubMedCrossRefGoogle Scholar
  17. 17.
    Cairns J. Discounting and health benefits: another perspective. Health Econ 1992; 1: 76–9PubMedCrossRefGoogle Scholar
  18. 18.
    Coyle D, Tolley K. The discounting of health benefits in the pharmacoeconomic analysis of drug therapies: an issue for debate. Pharmacoeconomics 1992; 2(2): 71–6CrossRefGoogle Scholar
  19. 19.
    Gudex C. Time preference, duration and health state valuation. Health Econ 1995; 4: 289–99PubMedCrossRefGoogle Scholar
  20. 20.
    Nicod P, Gilpin E, Dittrich H, et al. Influence on prognosis and morbidity of left ventricular ejection fraction with and without signs of left ventricular failure after myocardial infarction. Am J Cardiol 1988; 61: 1165–71PubMedCrossRefGoogle Scholar
  21. 21.
    Robinson R. Cost utility analysis. BMJ 1993; 307: 859–62PubMedCrossRefGoogle Scholar
  22. 22.
    Levin LA, Jönsson B. Cost-effectiveness of thrombolysis: a randomised study of intravenous rtPA in suspected myocardial infarction. Eur Heart J 1992; 13: 2–8PubMedGoogle Scholar
  23. 23.
    van Hout BA, Wielink G, Bonsel GJ, et al. Heart failure and ACE inhibitors. Rotterdam: Erasmus University, 1993. IMTA report no.: 92.13Google Scholar
  24. 24.
    Mason J, Drummond M, Torrance G. Some guidelines on the use of cost-effectiveness league tables. BMJ 1993; 306: 570–2PubMedCrossRefGoogle Scholar
  25. 25.
    Sculpher MJ, Seed P, Anderson RA, et al. Health service costs of coronary angioplasty and coronary artery bypass surgery: the Randomised Intervention Treatment of Angina (RITA) trial. Lancet 1994; 344: 927–30PubMedCrossRefGoogle Scholar
  26. 26.
    Fletcher A. Cost effective analyses in the treatment of high blood pressure. J Hum Hypertens 1992; 6: 437–45PubMedGoogle Scholar
  27. 27.
    Drummond M, Coyle D. Assessing the economic value of antihypertensive medicines. J Hum Hypertens 1992; 6: 495–501PubMedGoogle Scholar
  28. 28.
    Anderson MR, Camm AJ. Implications for present and future applications of the implantable cardioverter-defibrillator resulting from the use of a simple model of cost efficacy. Br Heart J 1993; 69: 83–92PubMedCrossRefGoogle Scholar
  29. 29.
    O’Brien BJ, Buxton MJ, Rushby JA. Cost effectiveness of the implantable cardioverter defibrillator: a preliminary analysis. Br Heart J 1992; 68: 241–5PubMedCrossRefGoogle Scholar
  30. 30.
    Goldman L, Sia B, Cook EF, et al. Costs and effectiveness of routine therapy with long-term beta-adrenergic antagonists after acute myocardial infarction. N Engl J Med 1988; 319: 152–7PubMedCrossRefGoogle Scholar
  31. 31.
    Olsson G, Levin LA, Rehnqvist N. Economic consequences of postinfarction prophylaxis with beta blockers: cost effectiveness of metoprolol. BMJ 1987; 294: 339–41PubMedCrossRefGoogle Scholar

Copyright information

© Adis International Limited 1997

Authors and Affiliations

  • Sylvia Hummel
    • 1
  • James Piercy
    • 1
  • Robert Wright
    • 2
  • Andrew Davie
    • 3
  • Adrian Bagust
    • 1
  • John McMurray
    • 3
  1. 1.York Health Economics ConsortiumUniversity of YorkYorkEngland
  2. 2.Department of CardiologyWestern General HospitalEdinburghScotland
  3. 3.Department of CardiologyWestern InfirmaryGlasgowScotland

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