Costs and effects of secondary prevention with perindopril in stable coronary heart disease in Poland: an analysis of the EUROPA study including 1251 Polish patients.
OBJECTIVE
To estimate the long-term impact of treatment with perindopril on costs and health effects in patients with stable coronary artery disease in Poland.


METHODS
The cost-effectiveness analysis was based on data from a randomized double-blind, placebo-controlled trial. A decision-tree analysis was employed, including Monte Carlo and bootstrapping techniques. This study was a sub-study of the EUROPA (European Trial on Reduction of Cardiac Events with Perindopril in Stable Coronary Artery Disease) trial (n = 12,218; mean follow-up 4.2 years). Resource use was based on data from Polish EUROPA study patients (n = 1251), while effectiveness was based on the whole EUROPA study. The health gain of perindopril in life-years was based on overall EUROPA study results, and the adapted Polish life expectancy of patients not dying during the trial. Costs were calculated in new Polish zloty (PLN), year 2003 values; euro1 = PLN4.053. Only direct healthcare costs related to cardiovascular events and medication use were studied.


RESULTS
When observed mortality was combined with life expectancy beyond the end of the study, perindopril use showed a gain in life expectancy of 0.182 life-years (SD +/- 0.129) at a cost of PLN1983 (SD +/- 103) with discounting of 5% per annum on costs and no discounting on effects. This resulted in an incremental cost-effectiveness ratio (ICER) of PLN10 896 per life-year gained. The probability that the ICER for perindopril was below the threshold of PLN60 000 was 88%. The overall results were insensitive to discount rates for costs and life-years.


CONCLUSIONS
Perindopril leads to a reduction in the risk of coronary events among patients with stable heart disease. When the expected improvement in life expectancy is combined with associated medical costs, there is a high probability that perindopril is cost effective, given the threshold of PLN60 000 per life-year gained.
Redekop
W Ken
WK
Institute for Medical Technology Assessment and Institute of Health Policy and Management, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands. w.redekop@erasmusmc.nl
Orlewska
Ewa
E
Maciejewski
Pawel
P
Rutten
Frans F H
FF
Niessen
Louis W
LW
D000806:Angiotensin-Converting Enzyme Inhibitors / Q000191:economics / Q000627:therapeutic use*; D003327:Coronary Disease / Q000188:drug therapy* / Q000191:economics / Q000401:mortality; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D005260:Female; D006801:Humans; D008017:Life Expectancy; D008297:Male; D008875:Middle Aged; D009010:Monte Carlo Method; D020913:Perindopril / Q000191:economics / Q000627:therapeutic use*; D011044:Poland; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D012306:Risk; D055502:Secondary Prevention
D000806:Angiotensin-Converting Enzyme Inhibitors; D020913:Perindopril
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