Original paper

The European Journal of Health Economics

, Volume 10, Issue 1, pp 111-119

First online:

An economic evaluation of a perindopril-based blood pressure lowering regimen for patients who have suffered a cerebrovascular event

  • Manouchehr TavakoliAffiliated withSchool of Management, University of St Andrews Email author 
  • , Neil PumfordAffiliated withNurseplus Ltd
  • , Mark WoodwardAffiliated withMount Sinai Medical School
  • , Alex DoneyAffiliated withNinewells Hospital and Medical School
  • , John ChalmersAffiliated withThe George Institute, University of Sydney
  • , Stephen MacMahonAffiliated withThe George Institute, University of Sydney
  • , Ronald MacWalterAffiliated withNinewells Hospital and Medical School

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Cerebrovascular disease (or stroke) is one of the main causes of long-term disability and the second leading cause of death worldwide. The economic impact of stroke is clearly seen, as it is the largest single cause of bed occupancy in hospitals in England and accounts for 6% of hospital costs. This analysis is the first to quantify the economic consequences of a blood pressure lowering regimen based on the PROGRESS study (perindopril-based regimen), for reducing future cardiovascular events.


A Markov decision analytical model was used to estimate the cost per quality adjusted life year (QALY) of blood pressure lowering in the treatment of patients presenting with a cerebrovascular event. The health states are based upon Barthel indices for which resource utilisation and health benefits have previously been estimated.


The participants for the economic analysis were obtained from the PROGRESS study database. 6,105 clinical study participants were recruited through both primary and secondary care centres.


The mean age was 64 years; 70% were male in the original study.


In the PROGRESS study, blood pressure lowering by a perindopril-based regimen was compared to standard care.

Main outcome measures

Cost per quality adjusted life year for the duration of the study (4 years) and for a time span of 20 years.


Using only direct hospital medical costs, the cost per QALY for a perindopril based regimen is £6,927 for the base study period and £10,133 for a 20-year time period. These results are sensitive to the cost of perindopril, the cost of the stroke unit, length of stay, and to a lesser extent, the cost of indapamide.


This analysis demonstrates a cost-effective treatment for patients suffering a cerebrovascular event with a blood pressure lowering regimen. The findings of this study are in line with current decisions and guidance by the national institute for health and clinical excellence (NICE) in England.


Blood pressure lowering Cerebrovascular Markov Cost-effectiveness