Cost-effectiveness of different ACE inhibitor treatment scenarios post-myocardial infarction

To assess the cost-effectiveness of three different treatment strategies for the use of ACE inhibitors after myocardial infarction. These were (a) a high risk (AIRE type) strategy, (b) an intermediate risk (SAVE type) strategy, and (c) initial, short-term treatment of all patients followed by long-term treatment according to (a) or (b).

Incremental costs per life year gained were calculated for each of the above scenarios. The most optimistic cost per life year gained over 10 years, for (a) was L1752 and for (b) was L2962. Strategy (c) increased the cost per life year gained of (a) to L2017 and (b) to L3110. The incremental cost-effectiveness ratio was found to be very sensitive to drug cost.

If a low cost ACE inhibitor is used, initial treatment of relatively unselected patients followed by long-term treatment of those at high and medium risk maximizes benefit at an acceptable cost. Use of an ACE inhibitor after myocardial infarction is very cost-effective by comparison with many other treatments.