An economic evaluation of valsartan for post-MI patients in the UK who are not suitable for treatment with ACE inhibitors.
OBJECTIVE
The overall objective of this study was to estimate the costs and outcomes associated with treatment with valsartan for post-myocardial infarction (post-MI) patients with left ventricular systolic dysfunction, heart failure, or both, who are not suitable for treatment with angiotensin-converting enzyme (ACE) inhibitors, compared to placebo.


METHODS
A Markov model, using data drawn from the Valsartan in Acute Myocardial Infarction (VALIANT) trial and other trials, was developed to predict the future health pathways, resource use, and costs for patients who have recently experienced an MI. Patients received either valsartan (mean dose 247 mg) or placebo. Cost data were drawn from national databases and published literature, although health outcome utility weights were derived from existing studies. Patient outcomes were modeled for 10 years, and incremental cost-effective ratios were calculated for valsartan compared with placebo.


RESULTS
Over a period of 10 years, a cohort of 1000 patients treated with valsartan experienced 147 fewer cardiovascular deaths, 37 fewer nonfatal MIs, and 95 fewer cases of heart failure than a cohort who received placebo. The incremental cost of valsartan, compared with placebo, was 2680 pound per patient, although the incremental effectiveness of valsartan was 0.5021 quality-adjusted life-years (QALYs) gained per patient. Therefore, the incremental cost per QALY for treatment with valsartan was 5338 pound. When analysis was undertaken using life-years rather than QALYs, the cost per life-year gained was 4672 pound.


CONCLUSIONS
For patients who are not suitable for treatment with ACE inhibitors, valsartan is a viable and cost-effective treatment for their management after an MI.
Taylor
Matthew
M
University of York, York Health Economics Consortium, York, UK. mt25@york.ac.uk
Scuffham
Paul A
PA
Chaplin
Stephen
S
Papo
Natalie L
NL
D047228:Angiotensin II Type 1 Receptor Blockers / Q000191:economics* / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000191:economics* / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000191:economics* / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D003625:Data Collection; D003657:Decision Making; D006801:Humans; D053208:Kaplan-Meier Estimate; D040541:Marketing; D008390:Markov Chains; D018803:Models, Economic; D015233:Models, Statistical; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000191:economics; D011594:Psychometrics; D019057:Quality-Adjusted Life Years; D013777:Tetrazoles / Q000191:economics* / Q000627:therapeutic use; D013997:Time Factors; D006113:United Kingdom; D014633:Valine / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use; D000068756:Valsartan
D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D013777:Tetrazoles; D000068756:Valsartan; D014633:Valine