A South African pharmaco-economic analysis of the Acute lnfarction Ramipril Efficacy (AIRE) Study

OBJECTIVES: Heart failure (HF) is a serious, prevalent health condition in industrialised countries where the incidence has been on the increase. The economic repercussions are costly, and therefore cost-effective medication is important in the overall management of the condition. It has been shown that angiotensin-converting enzyme (ACE) inhibitors are clinically effective in the management of HF. Ramipril has been shown to reduce mortality and the probability of hospitalisation in post-myocardial infarction (MI) patients. Internationally, the use of this drug has proved to be cost-effective. The objective of this study was to investigate the economic implications of using ramipril in South Africa for post-MI patients with HF. METHODOLOGY: An incremental cost-effectiveness analysis was performed comparing the use of ramipril and placebo in post-MI patients with HF who were receiving standard therapy. The economic impacts included drug acquisition costs and savings on hospitalisation; these were evaluated based on the clinical benefits of using ramipril in terms of life-years gained (LYG). The cost-utility of the use of ramipril was determined to provide an incremental cost per quality-adjusted life-year (QALY). Sensitivity analyses were performed on the major economic variables; discounting of future costs and savings was performed at rates of 0%, 5 % and 10 %. RESULTS: The use of ramipril results in an incremental cost/LYG of R16 808 and a total incremental cost per patient per month of R107 over 3.8 years. When the quality of life of the patients is taken into account, the cost-utility analysis shows an incremental cost/QALY of R21 382 for those younger than 65 years of age and R18 029 for those older than 65 years. The pharmaco-economic model was robust and consistent when tested at the extremes of the major variables, including costs, savings and discount rates. CONCLUSION: The results indicate that it is cost-effective to administer ramipril in addition to standard therapy for post-MI patients with HF in South Africa.