An economic evaluation of a perindopril-based blood pressure lowering regimen for patients who have suffered a cerebrovascular event.
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.
Tavakoli
Manouchehr
M
School of Management, University of St Andrews, St Andrews, KY16 9SS, UK. mt@st-andrews.ac.uk
Pumford
Neil
N
Woodward
Mark
M
Doney
Alex
A
Chalmers
John
J
MacMahon
Stephen
S
Macwalter
Ronald
R
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*
D000806:Angiotensin-Converting Enzyme Inhibitors; D020913:Perindopril