Cost implications of the use of ramipril in high-risk patients based on the Heart Outcomes Prevention Evaluation (HOPE) study.
BACKGROUND
The HOPE study has demonstrated that ramipril is beneficial (ie, prevents cardiovascular death, myocardial infarction, and stroke) for a broad range of patients without evidence of left ventricular dysfunction or heart failure who are at high risk for cardiovascular event. In this study, we report the cost implications, in both the United States and Canada, of the use of ramipril after the HOPE study.


RESULTS
A third-party perspective was chosen (Medicare for the United States and Ministry of Health for Canada). We calculated the costs of the management strategies of ramipril and placebo. An annual discount rate of 3% was used over the 4.5 years of follow-up. Sensitivity analyses were performed. Costs are reported in United States dollars and in Canadian dollars, respectively. The total costs per patient (including acquisition costs of ramipril) were not different between the groups in both countries (United States, $13 520 versus $13 631; Canada, $8702 versus $8588). From the distribution of cases in the bootstrap analysis, we found that 90% of cases fall either into a cost-neutral or cost-saving situation (64% in United States and 27% in Canada) or into a cost-effectiveness situation with an incremental cost-effectiveness ratio <$10 000 (in respective currency) per primary event saved.


CONCLUSIONS
On the basis of these results, we suggest that the use of ramipril is likely to represent an efficient use of resources in both countries. These findings support the use of ramipril in populations included in the HOPE study.
Lamy
Andre
A
CADENCE Research Group, McMaster University, Hamilton, Ontario, Canada. lamya@mcmaster.ca
Yusuf
Salim
S
Pogue
Janice
J
Gafni
Amiram
A
D000806:Angiotensin-Converting Enzyme Inhibitors / Q000191:economics* / Q000627:therapeutic use*; D002170:Canada; D003362:Cost-Benefit Analysis; D016527:Drug Costs / Q000706:statistics & numerical data*; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006331:Heart Diseases / Q000191:economics* / Q000401:mortality / Q000517:prevention & control*; D006760:Hospitalization; D006801:Humans; D015337:Multicenter Studies as Topic; D009203:Myocardial Infarction / Q000517:prevention & control; D010919:Placebos / Q000191:economics; D017257:Ramipril / Q000191:economics* / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D012306:Risk; D012680:Sensitivity and Specificity; D020521:Stroke / Q000517:prevention & control; D016896:Treatment Outcome; D014481:United States
D000806:Angiotensin-Converting Enzyme Inhibitors; D010919:Placebos; D017257:Ramipril