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Myocardial Infarction and Functional Outcome Assessment in Pigs
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Cost-effectiveness of captopril therapy after myocardial infarction

J Tsevat1, D Duke, L Goldman

  • 1Section for Clinical Epidemiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.

Journal of the American College of Cardiology
|October 1, 1995
PubMed

Insights

Captopril therapy is a cost-effective treatment for myocardial infarction survivors with reduced ejection fraction. This intervention offers favorable incremental cost-effectiveness ratios compared to other treatments.

Area of Science:

  • Cardiovascular Medicine
  • Health Economics
  • Clinical Pharmacology

Background:

  • The Survival and Ventricular Enlargement (SAVE) trial demonstrated captopril's efficacy in improving survival for myocardial infarction (MI) survivors with ejection fraction (EF) ≤ 40%.
  • Ancillary studies are crucial for evaluating the economic implications of life-extending therapies.
  • Understanding the cost-effectiveness of captopril is vital for resource allocation in cardiovascular care.

Purpose of the Study:

  • To assess the cost-effectiveness of captopril therapy in survivors of myocardial infarction (MI).
  • To compare the costs associated with captopril therapy to achieve survival benefits against other medical interventions.
  • To provide economic data supporting clinical decisions for post-MI care.

Main Methods:

  • A decision-analytic model was developed to evaluate cost-effectiveness in 50- to 80-year-old MI survivors with EF ≤ 40%.
  • Data from the SAVE trial, including costs, utilities (quality-of-life weights), and 4-year survival, were utilized.
  • Long-term survival was projected using a Markov model, with analyses considering both persistent and limited benefits of captopril beyond 4 years.

Main Results:

  • In limited-benefit analyses, incremental cost-effectiveness ranged from $3,600/quality-adjusted life-year (QALY) for 80-year-olds to $60,800/QALY for 50-year-olds.
  • Persistent-benefit analyses showed ratios from $3,700 to $10,400/QALY, varying by age.
  • Sensitivity analyses indicated that outcomes were generally robust, with favorable ratios even in worst-case scenarios for older age groups.

Conclusions:

  • Captopril therapy demonstrates favorable cost-effectiveness for MI survivors aged 50-80 with low ejection fraction.
  • The findings suggest captopril is a valuable intervention when compared to other treatments for this patient population.
  • Economic evaluations support the clinical benefits of captopril in long-term post-MI management.
Abstract

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