Author + information
- Received November 17, 1994
- Revision received May 16, 1995
- Accepted May 24, 1995
- Published online October 1, 1995.
- Joel Tsevat, MD, MPH†,*,
- Daniella Duke, MDa,†,
- Lee Goldman, MD, MPH, FACC‡,
- Marc A. Pfeffer, MD, PhD, FACCa,†,
- Gervasio A. Lamas, MD, FACCb,§,
- Jane R. Soukup, MSa,†,
- Karen M. Kuntz, ScDa,†∥ and
- Thomas H. Lee, MD, SM, FACCa,†∥,*
- ↵*Address for correspondence: Dr. Thomas H. Lee, Section for Clinical Epidemiology, Brigham and Women's Hospital, 75 Francis Street, Boston, Massachusetts 02115.
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 showed that captopril therapy improves survival in survivors of myocardial infarction with an ejection fraction ≤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 ≤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.
↵* Present address: Section of Outcomes Research, Division of General Internal Medicine, University of Cincinnati Medical Center, Cincinnati, Ohio 45267.
This study was funded by a grant from the investigators comprising the SAVE Ancillary Studies Committee. The SAVE trial and the Ancillary Studies Committee were funded by the Bristol-Myers Squibb Institute for Pharmaceutical Research, Princeton, New Jersey. All of the data pertinent to this analysis were collected and analyzed in blinded manner by the authors, without knowledge of treatment group. The funding agency was not involved in any of the analyses or in the preparation of the manuscript. Dr. Lee is the recipient of an Established Investigator Award (900119) from the American Heart Association, Dallas, Texas. This work was presented at the joint session of the 1993 annual meetings of the Society of General Internal Medicine and the American Federation for Clinical Research, Washington, D.C., May 1993.
All editorial decisions for this article, including selection of referees, were made by a Guest Editor. This policy applies to all articles with authors from the University of California San Francisco.
- Received November 17, 1994.
- Revision received May 16, 1995.
- Accepted May 24, 1995.
- American College of Cardiology