Economic aspects of treatment with captopril for patients with asymptomatic left ventricular dysfunction in The Netherlands

Abstract

Objective. To estimate the costs and effects of preventive treatment with captopril compared with the current treatment policy in patients with asymptomatic left ventricular dysfunction after a myocardial infarction. Methods. Estimates of effects are based on the results of the SAVE trial. Costs are estimated on the basis of current treatment patterns in four Dutch hospitals. All knowledge is incorporated in a mathematical model extrapolating the SAVE results to 20 years. Results and conclusions. Captopril treatment is expected to increase survival at certain costs. The average additional costs per patient are estimated at DF 12491 in 4 years and at DF 18723 in 20 years of treatment. Costs per additional survivor after 4 years are estimated at DF 169126. After extrapolation of the results of the SAVE trial to 20 years, costs per life-year gained can be estimated at DF 115799. From univariate sensitivity analysis it appears that the results are highly sensitive for the costs of treatment with captopril and the occurrence and prevention of clinical heart failure. Varying all estimates randomly between upper and lower limits - in 5000 simulations - an estimate of costs per life-year gained of DF 115729 is made for 20 years of treatment, with 95% of all estimates between DF 10 and DF 150000. On a national level, undiscounted costs are expected to increase up to approximately DF 142 million annually during the first 40 years after introduction of the preventative strategy.