Determining the cost-effectiveness of preventing cardiovascular disease: are estimates calculated over the duration of a clinical trial adequate?

The Canadian Journal of Cardiology
Steven A GroverIlka Lowensteyn

Abstract

Economic analyses of randomized clinical trials often focus only on the results that are observed during the study. However, for many preventive interventions, associated costs and benefits will accrue over a patient's remaining lifetime. To determine the importance of the chosen time horizon, the cost-effectiveness (C/E) of ramipril therapy was calculated and compared in the Heart Outcomes Prevention Evaluation (HOPE), the Microalbuminuria, Cardiovascular, and Renal Outcomes in HOPE (MICRO-HOPE) and the Acute Infarction Ramipril Efficacy (AIRE) study versus the entire life expectancy (L/E) of potential patients. The Cardiovascular Disease Life Expectancy model, a validated Markov model, was calibrated to accurately forecast the results of each trial. These results were then extrapolated over the remaining L/E of hypothetical patients 55 to 75 years of age. The predicted change in L/E and associated direct health care costs for Canadians were calculated and discounted 3% annually. In HOPE, the forecasted increased L/E averaged 0.06 years during the five-year study versus 1.3 years over the remaining years of L/E. The associated C/E of ramipril was $15,000 per year of life saved (YOLS) over the study duration and $8,500/YOLS ove...Continue Reading

References

Feb 26, 2003·Circulation·Andre LamyUNKNOWN Heart Outcomes Prevention Evaluation Investigators
Mar 18, 2003·The Annals of Pharmacotherapy·Cathryn A CarrollRobert W Piepho

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Citations

Jan 18, 2013·ClinicoEconomics and Outcomes Research : CEOR·Matthew R ReynoldsPeter Lindgren
Jan 12, 2010·International Journal of Technology Assessment in Health Care·Nele JacobsNeree Claes

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