title: An economic evaluation of a perindopril-based blood pressure lowering regimen for patients who have suffered a cerebrovascular event.
abstract: OBJECTIVE
  Cerebrovascular disease (or stroke) is one of the main causes of long-term disability and the second leading cause of death worldwide. The economic impact of stroke is clearly seen, as it is the largest single cause of bed occupancy in hospitals in England and accounts for 6% of hospital costs. This analysis is the first to quantify the economic consequences of a blood pressure lowering regimen based on the PROGRESS study (perindopril-based regimen), for reducing future cardiovascular events.
  
  
  METHODS
  A Markov decision analytical model was used to estimate the cost per quality adjusted life year (QALY) of blood pressure lowering in the treatment of patients presenting with a cerebrovascular event. The health states are based upon Barthel indices for which resource utilisation and health benefits have previously been estimated.
  
  
  METHODS
  The participants for the economic analysis were obtained from the PROGRESS study database. 6,105 clinical study participants were recruited through both primary and secondary care centres.
  
  
  METHODS
  The mean age was 64 years; 70% were male in the original study.
  
  
  METHODS
  In the PROGRESS study, blood pressure lowering by a perindopril-based regimen was compared to standard care.
  
  
  METHODS
  Cost per quality adjusted life year for the duration of the study (4 years) and for a time span of 20 years.
  
  
  RESULTS
  Using only direct hospital medical costs, the cost per QALY for a perindopril based regimen is pound 6,927 for the base study period and pound 10,133 for a 20-year time period. These results are sensitive to the cost of perindopril, the cost of the stroke unit, length of stay, and to a lesser extent, the cost of indapamide.
  
  
  CONCLUSIONS
  This analysis demonstrates a cost-effective treatment for patients suffering a cerebrovascular event with a blood pressure lowering regimen. The findings of this study are in line with current decisions and guidance by the national institute for health and clinical excellence (NICE) in England.
authors.affiliation: School of Management, University of St Andrews, St Andrews, KY16 9SS, UK. mt@st-andrews.ac.uk
authors.forename: Manouchehr
authors.initials: M
authors.lastname: Tavakoli
authors.forename: Neil
authors.initials: N
authors.lastname: Pumford
authors.forename: Mark
authors.initials: M
authors.lastname: Woodward
authors.forename: Alex
authors.initials: A
authors.lastname: Doney
authors.forename: John
authors.initials: J
authors.lastname: Chalmers
authors.forename: Stephen
authors.initials: S
authors.lastname: MacMahon
authors.forename: Ronald
authors.initials: R
authors.lastname: Macwalter
mesh_terms: D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000191:economics* / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D005260:Female; D017721:Hospital Costs; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy* / Q000191:economics*; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D009010:Monte Carlo Method; D020913:Perindopril / Q000191:economics* / Q000627:therapeutic use; D019057:Quality-Adjusted Life Years; D020521:Stroke / Q000150:complications / Q000191:economics* / Q000517:prevention & control*
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D020913:Perindopril