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Estimating the Cost Effectiveness of Ramipril used for Specific Clinical Indications

Comparing the Outcomes in Four Clinical Trials with a Common Economic Model

  • Original Research Article
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Abstract

Background and objectives

Economic analyses of drug therapies are highly dependent on the clinical indications for treatment. The cost effectiveness of ramipril has been evaluated in numerous studies, usually based on the results of one specific clinical trial. We estimated the cost effectiveness of this drug across a range of currently accepted therapeutic indications, using a single health economic model and adjusted for quality of life, to compare the different outcomes observed in four clinical trials.

Methods

The cardiovascular life expectancy model, a validated Markov model, was calibrated to accurately forecast the results of four trials including AIRE, HOPE, Micro-HOPE, and REIN. We then extrapolated these results over the remaining life expectancy of the patients enrolled in each study and adjusted for the quality of life associated with the observed outcomes. The cost per quality-adjusted life-year (QALY) was then calculated from the perspective of the Canadian healthcare system incorporating the estimated direct healthcare costs associated with treatments and outcomes.

Results

After discounting all costs and outcomes 3% annually, the benefits associated with ramipril ranged from 0.74 QALYs in the AIRE study to 1.22 QALYs in Micro-HOPE. Treatment was estimated to be costsaving for some patient groups, such as those in REIN. The highest cost-effectiveness ratio was observed among individuals enrolled in HOPE ($Can20 000 per QALY in 2002).

Conclusion

Treatment with ramipril appears to be economically attractive across a wide range of patient groups, including those with increased coronary risk and/or diabetes mellitus (HOPE and Micro-HOPE), those with congestive heart failure (AIRE), and those with non-diabetic nephropathy (REIN).

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Acknowledgments

Dr Grover, Mr Coupal, and Dr Lowensteyn have received research grants from Pfizer, Aventis, and AstaZeneca. Dr Grover has also been a consultant or participant on advisory boards for Sanofi-Aventis, Merck, AstraZeneca, and Pfizer. This study was investigator-initiated and funded by AstraZeneca Canada Inc., located in Mississauga, Ontario, Canada. All analyses were performed by the study investigators and the manuscript was prepared solely by the authors. The sponsor was permitted to review the manuscript, but the final decision about content was retained exclusively by the authors.

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Authors and Affiliations

  1. Centre for the Analysis of Cost-Effective Care and the Divisions of General Internal Medicine and Clinical Epidemiology, Departments of Medicine and Epidemiology and Biostatistics, Research Institute, The McGill University Health Centre, McGill University, 687 Pine Avenue West, V Building, H3A 1A1, Montreal, Quebec, Canada

    Steven A. Grover, Louis Coupal & Ilka Lowensteyn

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  1. Steven A. Grover
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  2. Louis Coupal
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  3. Ilka Lowensteyn
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Correspondence to Steven A. Grover.

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Grover, S.A., Coupal, L. & Lowensteyn, I. Estimating the Cost Effectiveness of Ramipril used for Specific Clinical Indications. Am J Cardiovasc Drugs 7, 441–448 (2007). https://doi.org/10.2165/00129784-200707060-00007

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