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Cost-effectiveness of perindopril compared to placebo to prevent cardio-vascular events in stable coronary heart disease
Authors:
L W Niessen, WK Redekop, JW Deckers1, FFH Rutten, Erasmus MC, Erasmus U - Rotterdam - Netherlands, 1Erasmus MC, Erasmus U - Rotterdam - Netherlands,
On behalf: EUROPA trial investigators
Topic(s):
Cost-effectiveness
Medical decision making
Secondary prevention
Epidemiology / prevention, other
The EUROPA study showed that treatment with perindopril, 8 mg, in patients with proven coronary artery disease (CAD) causes a significant 20% relative risk reduction in cardio-vascular death, non fatal MI and cardiac arrest compared to placebo. This study estimates medical costs for cardiovascular disease per patient, and costs per life year gained per patient in The Netherlands, France, Italy and Poland.
All data from the four-year randomized trial of 12,218 patients in 24 countries are used. A Monte Carlo analysis estimates total life-years lived in each arm, using a country-specific life table corrected for excess age-specific cardiovascular risk observed in the control arm. Costs are computed using individual data on length of hospital stay, procedures, type and number of events and country-specific unit prices, from country-specific datasets,using sampling with replacement. Uncertainties regarding the incremental cost-effectiveness ratio (ICER) are presented as a confidence ellipse on the cost-effectiveness plane.
The outcomes for each country (Table) vary from 0.182 to 0.208 life years gained per patient lifetime and from 462 to 1,861 euros in medical costs per patient, at a 3% discount rate (large SEs). Country point estimates for the ICER range from 2,536 to 8,904 euros per life-year gained. The probability that the ICER for a country falls below the threshold value of 20,000 euros varies from 73% to 92%; at a threshold of 30,000 euros this range is between 80% to 94%. Outcomes are sensitive to the discount rate for life years.
Given prevailing ICER thresholds, perindopril very likely is cost-effective.
Table. Cost-effectiveness of perindopril
|
Netherlands |
France |
Italy |
Poland |
|
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|
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|
Health gain per patient (life years) |
0.194 |
0.207 |
0.209 |
0.182 |
SE |
(0.152) |
(0.158) |
(0.159) |
(0.120) |
Change in medical costs per patient (euros) |
1,121 |
1,537 |
1,861 |
462 |
SE |
(142) |
(78) |
(62) |
(25) |
Cost-effectiveness ratio (euros/life year) |
5,778 |
7,425 |
8,904 |
2,630 |
Proability that ICER < 30.000 euros |
84 |
80% |
83% |
94% |
Probability that ICER < 20,000 euros |
80% |
73% |
77% |
92% |
Costs are in 2003 euros, discounted at 3%. SE: standard error.
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