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European Heart Journal 1997 18(9):1411-1415;
Copyright © 1997 by the European Society of Cardiology.
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© 1997 The European Society of Cardiology

Cost-effectiveness of different ACE inhibitor treatment scenarios post-myocardial infarction

J. J. V. McMurray, A. McGuire*, A. P. Davie and D. Hughes*

Medical Research Council's Clinical Research Initiative in Heart Failure, University of Glasgow London, U.K.
*Department of Economics, City University London, U.K.

revised 21 January 1997; accepted 28 January 1997.

Correspondence: Professor J. McMurray, MRC CRI in Heart Failure, West Medical Building, University of Glasgow, Glasgow G12 8QQ, U.K.

Abstract

AIMS: To assess the cost-effectiveness of three different treatment strategies for the use of ACE inhibitors after myocardial infarction. These were (a) a high risk (AIRE type) strategy, (b) an intermediate risk (SAVE type) strategy, and (c) initial, short-term treatment of all patients followed by long-term treatment according to (a) or (b).

METHODS AND RESULTS: Incremental costs per life year gained were calculated for each of the above scenarios. The most optimistic cost per life year gained over 10 years, for (a) was £1752 and for (b) was £2962. Strategy (c) increased the cost per life year gained of (a) to £2017 and (b) to £3110. The incremental cost-effectiveness ratio was found to be very sensitive to drug cost.

CONCLUSIONS: If a low cost ACE inhibitor is used, initial treatment of relatively unselected patients followed by long-term treatment of those at high and medium risk maximizes benefit at an acceptable cost. Use of an ACE inhibitor after myocardial infarction is very cost-effective by comparison with many other treatments.

Key Words: Myocardial infarction • ACE inhibitors • cost-effectiveness analysis


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