Cost effectiveness of ramipril treatment for cardiovascular risk reduction

Abstract

Objective: To assess the cost effectiveness of ramipril treatment in patients at low, medium, and high risk of cardiovascular death.

Design: Population based cost effectiveness analysis from the perspective of the health care provider in the UK. Effectiveness was modelled using data from the HOPE (heart outcome prevention evaluation) trial. The life table method was used to predict mortality in a medium risk cohort, as in the HOPE trial (2.44% annual mortality), and in low and high risk groups (1% and 4.5% annual mortality, respectively).

Setting: UK population using 1998 government actuary department data.

Main outcome measure: Cost per life year gained at five years and lifetime treatment with ramipril.

Results: Cost effectiveness was pound36 600, pound13 600, and pound4000 per life year gained at five years and pound5300, pound1900, and pound100 per life year gained at 20 years (lifetime treatment) in low, medium, and high risk groups, respectively. Cost effectiveness at 20 years remained well below that of haemodialysis ( pound25 000 per life year gained) over a range of potential drug costs and savings. Treatment of the HOPE population would cost the UK National Health Service (NHS) an additional pound360 million but would prevent 12 000 deaths per annum.

Conclusions: Ramipril is cost effective treatment for cardiovascular risk reduction in patients at medium, high, and low pretreatment risk, with a cost effectiveness comparable with the use of statins. Implementation of ramipril treatment in a medium risk population would result in a major reduction in cardiovascular deaths but would increase annual NHS spending by pound360 million.

Figure 1

Cost effectiveness of ramipril treatment at 5, 10, 15, and 20 years in patients with low (1.0%), medium (2.44%), and high (4.5%) annual mortality rates. Haemodialysis has a cost effectiveness of £25 000 per life year gained. For additional data see eHeart.

Figure 2

Cost effectiveness of lifelong (20 year) treatment with ramipril in low, medium, and high risk populations related drug cost at 50%, 100%, and 200% of present prices. For additional data see eHeart.

Figure 3

Cost effectiveness of ramipril treatment continued for 5, 10, 15, and 20 years in a low risk population. Cost effectiveness of haemodialysis is £25 000 per life year gained (shown as dotted line). (A) The effect of varying drug costs. (B) The effect of varying potential savings. For additional data see eHeart.

Figure 4

Comparison of cost effectiveness of ramipril treatment with other cardiovascular and non-cardiovascular interventions. Estimates from previous studies are in 1994-1995 UK pounds.^{7 9 23 24 35} ACEI, angiotensin converting enzyme inhibitor; HT, hypertension; MI, myocardial infarction. See text for explanation of trial acronyms.