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European Heart Journal 1996 17(5):731-740;
Copyright © 1996 by the European Society of Cardiology.
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© The European Society of Cardiology

Heart failure

Economic aspects of treatment with captopril for patients with asymptomatic left ventricular dysfunction in The Netherlands

B. C. Michel*,, M. J. Al*, W. J. Remme{dagger}, J. H. Kingma{ddagger}, J. A. Kragten||, R. Van Nieuenhuizen and B. A. Van Hout*

*Institute for Medical Technology Assessment, Erasmus University Rotterdam
{dagger}STICARES Cardiovascular Research Foundation Rotterdam
{ddagger}St Antonious Hospital Nieuivegein
||de Wever Hospital Heerlen
¶Rijnstate Hospital DH, Arnhem The Netherlands

Received 20 July 1995; accepted 7 August 1995.

Correspondence: Bowine C. Michel MD, PhD, Institute for Medical Technology Assessment, Erasmus University, Rotterdam, PO Box 1738, 3000 DR Rotterdam, The Netherlands

Abstract

OBJECTIVE: To estimate the costs and effects of preventive treatment with captopril compared with the current treatment policy in patients with asymptomatic left ventricular dysfunction after a myocardial infarction.

METHODS: Estimates of effects are based on the results of the SAVE trial. Costs are estimated on the basis of current treatment patterns in four Dutch hospitals. All knowledge is incorporated in a mathematical model extrapolating the SAVE results to 20 years.

RESULTS AND CONCLUSIONS: Captopril treatment is expected to increase survival at certain costs. The average additional costs per patient are estimated at DFI 2 491 in 4 years and at DFI 8 723 in 20 years of treatment. Costs per additional survivor after 4 years are estimated at DFI 69 126. After extrapolation of the results of the SAVE trial to 20 years, costs per life-year gained can be estimated at DFI 15 799. From ursivariate sensitivity analysis it appears that the results are highly sensitive for the costs of treatment with captopril and the occurrence and prevention of clinical heart failure. Varying all estimates randomly between upper and lower limits— in 5000 simulations—an estimate of costs per life-year gained of DFI 15 729 is made for 20 years of treatment, with 95% of all estimates between DFI 0 and DFI 50 000. On a national level, undiscounted costs are expected to increase up to approximately DFI 42 million annually during the first 40 years after introduction of the preventativae strategy.

Key Words: Captopril • heart failure • prevention • angiotensin-converting enzyme inhibitors • cost-effectiveness • simulation • model


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