Myocardial Infarction: captopril was cost-effective.

Clinical bottom line (level 1b)

In patients who had a myocardial infarction, captopril was increasingly cost-effective with age between 50 and 80 years.

Tsevat et al: journal of the American College of Cardiology 1995; 26 (914): 919-

Expires March 2003

The study

Markov decision analysis
Setting: general hospital, USA

Data was taken from a randomised, controlled trial of captopril versus placebo.

Viewpoint: Health care system
Benefit assessment: quality-adjusted life years, based on an analysis conducted on 82 patients from within the trial.
Resources and costs: Cost estimates were based on actual resource utilisation of trial patients.Reviewers assigned each hospital period a diagnostic-relates group reimbursement rate plus a physician fee based on the Resource-Based Relative Value Scale. The physician fee was calculated on the basis of average length of stay using the median reimbursement rate for the initial hospital day, for each subsequent day and for the discharge day. Each cardiac medication was given a wholesale cost plus a dispensing cost of $4.24/ 1 month supply, the average of three published rates. Hospital stay and cardiac medication costs derived from the patients in one centre, were applied to all the other patients. Captopril therapy cost was based on the average daily dose in milligrams of all patients and was $0.0274/mg ($2.61/full dose of 50 mg three times daily, plus dispensing cost. To estimate out patient costs, each patient was assumed to have three outpatient visits plus the average number of unscheduled visits in each year of the trial. All costs were converted to 1991 US dollars and were discounted at 5%/year.
Sensitivity analysis: captopril cost, cardiac medication cost, hospital cost, outpatient cost and utilities, and captopril therapy incurring costs but yielding no long-term benefit, lower utility and no savings in hospital costs, outpatient follow-up costs and costs of other medications

The evidence

intervention	cost
50 year old patients	$60,800/quality-adjusted life year ( incremental cost )
60 year old patients	$9,000/quality-adjusted life year ( incremental cost )
70 year old patients	$4,900/quality-adjusted life year ( incremental cost )
80 year old patients	$3,600/quality-adjusted life year ( incremental cost )

Citation

Tsevat J, Duke D, Goldman L, et al: Cost-effectiveness of captopril therapy after myocardial infarction. journal of the American College of Cardiology 1995; 26 (914): 919-

_{Clinical Question.}

_Patient	_{myocardial infarction}
_{Intervention or Exposure}	_captopril
_Comparison	_placebo
_Outcome	_{cost-effectiveness}