title: Cost-effectiveness of captopril therapy after myocardial infarction.
abstract: OBJECTIVE
  This study sought to assess the cost-effectiveness of captopril therapy for survivors of myocardial infarction.
  
  
  BACKGROUND
  The recent randomized, controlled Survival and Ventricular Enlargement (SAVE) trial showed that captopril therapy improves survival in survivors of myocardial infarction with an ejection fraction < or = 40%. The present ancillary study was designed to determine how the costs required to achieve this increase in survival compared with those of other medical interventions.
  
  
  METHODS
  We developed a decision-analytic model to assess the cost-effectiveness of captopril therapy in 50- to 80-year old survivors of myocardial infarction with an ejection fraction < or = 40%. Data on costs, utilities (health-related quality of life weights) and 4-year survival were obtained directly from the SAVE trial, and long-term survival was estimated using a Markov model. In one set of analyses, we assumed that the survival benefit associated with captopril therapy would persist beyond 4 years (persistent-benefit analyses), whereas in another set we assumed that captopril therapy incurred costs but no survival benefit beyond 4 years (limited-benefit analyses).
  
  
  RESULTS
  In the limited-benefit analyses, the incremental cost-effectiveness of captopril therapy ranged from $3,600/quality-adjusted life-year for 80-year old patients to $60,800/quality-adjusted life-year for 50-year old patients. In the persistent-benefit analyses, incremental cost-effectiveness ratios ranged from $3,700 to $10,400/quality-adjusted life-year, depending on age. The outcome was generally not sensitive to changes in estimates of variables when they were varied individually over wide ranges. In a "worst-case" analysis, incremental cost-effectiveness ratios for captopril therapy remained favorable ($8,700 to $29,200/quality-adjusted life-year) for 60- to 80-year old patients but were higher ($217,600/quality-adjusted life-year) for 50-year old patients.
  
  
  CONCLUSIONS
  We conclude that the cost-effectiveness of captopril therapy for 50- to 80-year old survivors of myocardial infarction with a low ejection fraction compares favorably with other interventions for survivors of myocardial infarction.
authors.affiliation: Section for Clinical Epidemiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: J
authors.initials: J
authors.lastname: Tsevat
authors.forename: D
authors.initials: D
authors.lastname: Duke
authors.forename: L
authors.initials: L
authors.lastname: Goldman
authors.forename: M A
authors.initials: MA
authors.lastname: Pfeffer
authors.forename: G A
authors.initials: GA
authors.lastname: Lamas
authors.forename: J R
authors.initials: JR
authors.lastname: Soukup
authors.forename: K M
authors.initials: KM
authors.lastname: Kuntz
authors.forename: T H
authors.initials: TH
authors.lastname: Lee
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000191:economics* / Q000627:therapeutic use*; D001900:Boston; D002216:Captopril / Q000191:economics* / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis / Q000379:methods; D003661:Decision Support Techniques; D016527:Drug Costs / Q000706:statistics & numerical data*; D005260:Female; D006784:Hospitals, Teaching / Q000191:economics; D006801:Humans; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000191:economics* / Q000401:mortality; D019057:Quality-Adjusted Life Years; D013318:Stroke Volume; D026712:Value of Life
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D002216:Captopril