title: 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.
abstract: 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.
authors.affiliation: 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
authors.forename: W Ken
authors.initials: WK
authors.lastname: Redekop
authors.forename: Ewa
authors.initials: E
authors.lastname: Orlewska
authors.forename: Pawel
authors.initials: P
authors.lastname: Maciejewski
authors.forename: Frans F H
authors.initials: FF
authors.lastname: Rutten
authors.forename: Louis W
authors.initials: LW
authors.lastname: Niessen
mesh_terms: 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
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D020913:Perindopril
references.citation: Heart. 2007 Sep;93(9):1081-6
references.pmid: 17135223
references.citation: Health Econ. 1994 Sep-Oct;3(5):309-19
references.pmid: 7827647
references.citation: Health Econ. 1998 Dec;7(8):723-40
references.pmid: 9890333
references.citation: Pharmacoeconomics. 2000 May;17(5):479-500
references.pmid: 10977389
references.citation: Circulation. 2003 Feb 25;107(7):960-5
references.pmid: 12600907
references.citation: Lancet. 2003 Sep 6;362(9386):782-8
references.pmid: 13678872
references.citation: Am Heart J. 2005 Mar;149(3):434-43
references.pmid: 15864231
references.citation: BMJ. 2005 Aug 20;331(7514):446-8
references.pmid: 16110075
references.citation: Stat Med. 2003 Jun 30;22(12):1955-76
references.pmid: 12802815
references.citation: N Engl J Med. 2000 Jan 20;342(3):145-53
references.pmid: 10639539
references.citation: Lancet. 1992 Nov 14;340(8829):1173-8
references.pmid: 1359258
references.citation: Eur Heart J. 2000 Sep;21(18):1502-13
references.pmid: 10973764
references.citation: Eur J Health Econ. 2003 Nov;4(4):296-303
references.pmid: 15609200
references.citation: Circulation. 1994 Oct;90(4):1731-8
references.pmid: 7923656