Low doses vs. high doses of the angiotensin converting-enzyme inhibitor lisinopril in chronic heart failure: a cost-effectiveness analysis based on the Assessment of Treatment with Lisinopril and Survival (ATLAS) study. The ATLAS Study Group.
OBJECTIVE
A cost-effectiveness analysis of high and low doses of the angiotensin-converting enzyme (ACE) inhibitor lisinopril in the treatment of chronic heart failure.


METHODS
A cost-effectiveness analysis using data from a randomized controlled trial, ATLAS, where 3164 patients with chronic heart failure were allocated to a high-dose (daily target dose 32.5-35 mg) or low-dose strategy (daily target dose 2.5-5.0 mg) of lisinopril. Differential costs were based on resource use data collected in the trial costed using UK unit costs. Cost-effectiveness analysis related differential costs to differential life-years during a 4-year trial follow-up.


RESULTS
The mean total number of hospital in-patient days per patient was 18. 5 in the high dose group and 22.5 in the low dose group. Over the whole duration of the trial, the mean (S.D.) daily dose of lisinopril in the high-dose group was 22.5 mg (15.7 mg) compared to 3.2 mg (2.5 mg) in the low-dose group. The mean difference in cost per patient was pound sterling 397 lower in the high-dose group [95% CI (high-dose-low-dose) - pound sterling 1263 to pound sterling 436]. Mean life-years per patient were 0.085 years higher in the high-dose group [95% CI (high-dose-low-dose) -0.0074 to 0.1706). Based on mean costs and life-years, high-dose therapy dominates low-dose (less costly and more effective). Allowing for uncertainty in mean costs and life-years, the probability of high-dose therapy being less costly than low dose was 82%. If a decision maker is willing to pay at least pound sterling 3600 per life-year gained, the probability of high-dose being more cost-effective was 92%.


CONCLUSIONS
The ATLAS Study showed that the treatment of heart failure with high-doses of lisinopril has a high probability of being more cost-effective than low-dose therapy.
Sculpher
M J
MJ
Centre for Health Economics, University of York, Helsington, York, YO10 5DD, UK. mjs23@york.ac.uk
Poole
L
L
Cleland
J
J
Drummond
M
M
Armstrong
P W
PW
Horowitz
J D
JD
Massie
B M
BM
Poole-Wilson
P A
PA
Ryden
L
L
D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage* / Q000191:economics / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D004311:Double-Blind Method; D016527:Drug Costs / Q000706:statistics & numerical data; D005260:Female; D006295:Health Resources / Q000706:statistics & numerical data; D006333:Heart Failure / Q000188:drug therapy* / Q000191:economics* / Q000401:mortality; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006801:Humans; D017706:Lisinopril / Q000008:administration & dosage* / Q000191:economics / Q000627:therapeutic use; D008297:Male; D006113:United Kingdom
D000806:Angiotensin-Converting Enzyme Inhibitors; D017706:Lisinopril