Costs and Effects of Secondary Prevention with Perindopril in Stable Coronary Heart Disease in Poland An Analysis of the EUROPA Study Including 1251 Polish Patients

• Published in: PharmacoEconomics Vol. 26; no. 10; pp. 861 - 877
• Main Authors: Redekop, W. Ken, Orlewska, Ewa, Maciejewski, Pawel, Rutten, Frans F. H., Niessen, Louis W.
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.01.2008; Adis International; Springer Healthcare | Adis; Springer; Springer Nature B.V
• Series: PharmacoEconomics
• Subjects: Angiotensin-Converting Enzyme Inhibitors - economics; Angiotensin-Converting Enzyme Inhibitors - therapeutic use; Biological and medical sciences; Blood pressure; Cardiac stress tests; Cardiology; Cardiology. Vascular system; Cardiovascular disease; Coronary Disease - drug therapy; Coronary Disease - economics; Coronary Disease - mortality; Coronary heart disease; Coronary vessels; Coronary-artery-disease; Cost analysis; Cost-Benefit Analysis; Cost-effectiveness; Decision Trees; Drug therapy; Drug toxicity and drugs side effects treatment; Female; Health Administration; Health care expenditures; Health Economics; Health technology assessment; Heart; Heart failure; Humans; Hypertension; Life Expectancy; Male; Medical sciences; Medical treatment; Medicine; Medicine & Public Health; Middle Aged; Miscellaneous (drug allergy, mutagens, teratogens...); Monte Carlo Method; Mortality; Original Research Article; Patients; Perindopril; Perindopril - economics; Perindopril - therapeutic use; Pharmacoeconomics and Health Outcomes; Pharmacology. Drug treatments; Poland; Public Health; Quality of Life Research; Randomized Controlled Trials as Topic; Retrospective Studies; Risk; Secondary Prevention; Studies; Vein & artery diseases; Poland; Europe; Discount Rate; Incremental Cost; EUROPA Study; Percutaneous Coronary Intervention; Coronary Artery Bypass Graft; Human; Enzyme; Enzyme inhibitor; Cardiovascular disease; Coronary heart disease; Survival; Prevention; Peptidases; Peptidyl-dipeptidase A; Health economy; Secondary effect; Hydrolases; Peptidyl-dipeptidases; Antihypertensive agent; Economic aspect; Perindopril; ACE inhibitor; Public health; Cost efficiency analysis
• ISSN: 1170-7690; 1179-2027
• DOI: 10.2165/00019053-200826100-00006

Objectives: To estimate the long-term impact of treatment with perindopril on costs and health effects in patients with stable coronary artery disease in Poland. Methods: The cost-effectiveness analysis was based on data from a randomized double-blind, placebo-controlled trial. A decision-tree analysis was employed, including Monte Carlo and bootstrapping techniques. This study was a sub-study of the EUROPA (European Trial on Reduction of Cardiac Events with Perindopril in Stable Coronary Artery Disease) trial (n = 12 218; mean follow-up 4.2 years). Resource use was based on data from Polish EUROPA study patients (n = 1251), while effectiveness was based on the whole EUROPA study. The health gain of perindopril in life-years was based on overall EUROPA study results, and the adapted Polish life expectancy of patients not dying during the trial. Costs were calculated in new Polish zloty (PLN), year 2003 values; €1 = PLN4.053. Only direct healthcare costs related to cardiovascular events and medication use were studied. Results: When observed mortality was combined with life expectancy beyond the end of the study, perindopril use showed a gain in life expectancy of 0.182 lifeyears (SD ± 0.129) at a cost of PLN1983 (SD ± 103) with discounting of 5% per annum on costs and no discounting on effects. This resulted in an incremental cost-effectiveness ratio (ICER) of PLN10 896 per life-year gained. The probability that the ICER for perindopril was below the threshold of PLN60 000 was 88%. The overall results were insensitive to discount rates for costs and life-years. Conclusions: Perindopril leads to a reduction in the risk of coronary events among patients with stable heart disease. When the expected improvement in life expectancy is combined with associated medical costs, there is a high probability that perindopril is cost effective, given the threshold of PLN60 000 per life-year gained.