COST-EFFECTIVENESS OF CAPTOPRIL THERAPY AFTER MYOCARDIAL-INFARCTION

Objectives. This study sought to assess the cost-effectiveness of captopril therapy for survivors of myocardial infarction. Background. The recent randomized, controlled Survival and Ventricular Enlargement (SAVE) trial shelved that captopril therapy improves survival in survivors of myocardial infarction with an ejection fraction less than or equal to 40%. The present ancillary study was designed to determine how the costs required to achieve this increase in survival compared with those of other medical interventions. Methods. We developed a decision analytic model to assess the cost-effectiveness of captopril therapy in 50- to 80-year old survivors of myocardial infarction with an ejection fraction less than or equal to 40%. Data on costs, utilities (health related quality of life weights) and 4-year survival were obtained directly from the SAVE trial, and long-term survival was estimated using a Markov model. In one set of analyses, we assumed that the survival benefit associated with captopril therapy would persist beyond 4 years (persistent benefit analyses), whereas in another set we assumed that captopril therapy incurred costs but no survival benefit beyond 4 years (limited benefit analyses). Results. In the limited-benefit analyses, the incremental cost-effectiveness of captopril therapy ranged from $3,600/quality-adjusted life year for 80-year old patients to $60,800/quality-adjusted life-year for 50-year old patients. In the persistent-benefit analyses, incremental cost effectiveness ratios ranged from $3,700 to $10,400/quality adjusted life-year, depending on age. The outcome was generally not sensitive to changes in estimates of variables when they were varied individually over wide ranges. In a ''worst-case'' analysis, incremental cost-effectiveness ratios for captopril therapy remained favorable ($8,700 to $29,200/quality-adjusted life-year) for 60- to 80-year old patients but were higher ($217,600/quality-adjusted life-year) for 50-year old patients. Conclusions. We conclude that the cost-effectiveness of captopril therapy for 50- to 80-year old survivors of myocardial infarction with a low ejection fraction compares favorably with other interventions for survivors of myocardial infarction.