Costs and Effects of Secondary Prevention with Perindopril in Stable Coronary Heart Disease in Poland
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Objectives: To estimate the long-term impact of treatment with perindopril on costs and health effects in patients with stable coronary artery disease in Poland.
Methods: The cost-effectiveness analysis was based on data from a randomized double-blind, placebo-controlled trial. A decision-tree analysis was employed, including Monte Carlo and bootstrapping techniques. This study was a sub-study of the EUROPA (European Trial on Reduction of Cardiac Events with Perindopril in Stable Coronary Artery Disease) trial (n = 12 218; mean follow-up 4.2 years). Resource use was based on data from Polish EUROPA study patients (n = 1251), while effectiveness was based on the whole EUROPA study. The health gain of perindopril in life-years was based on overall EUROPA study results, and the adapted Polish life expectancy of patients not dying during the trial. Costs were calculated in new Polish zloty (PLN), year 2003 values; €1 = PLN4.053. Only direct healthcare costs related to cardiovascular events and medication use were studied.
Results: When observed mortality was combined with life expectancy beyond the end of the study, perindopril use showed a gain in life expectancy of 0.182 lifeyears (SD ± 0.129) at a cost of PLN1983 (SD ± 103) with discounting of 5% per annum on costs and no discounting on effects. This resulted in an incremental cost-effectiveness ratio (ICER) of PLN10 896 per life-year gained. The probability that the ICER for perindopril was below the threshold of PLN60 000 was 88%. The overall results were insensitive to discount rates for costs and life-years.
Conclusions: Perindopril leads to a reduction in the risk of coronary events among patients with stable heart disease. When the expected improvement in life expectancy is combined with associated medical costs, there is a high probability that perindopril is cost effective, given the threshold of PLN60 000 per life-year gained.
- 5.Efron B, Tibshirani R. An introduction to the bootstrap. New York: Chapman and Hill, 1993Google Scholar
- 11.Orlewska E, Cel M. Standard list of inpatient costs [in Polish]. Farmakoekonomika 2003; 6 (2): 1–22Google Scholar
- 12.National Health Fund Management Resolution 164/2004 of 01/07/2004 on setting the catalog of inpatient medical services (appendix 1) [in Polish]. Warsaw: National Health Fund (Poland), 2004Google Scholar
- 13.Eurostat. Harmonized Indices of Consumer Prices (HICPs). All items: index[online]. Available from URL: http://epp.eurostat.ec.europa.eu/portal/page?_pageid=1996,39140985&_dad= portal&_schema=PORTAL&screen=detailref&language=en &product=EU_shorties&root=EU_shorties/shorties/euro_cp/cp000 [Accessed 2008 Jun 5]Google Scholar
- 14.Data on file, IMS Poland National Data 2004 (IMS data view).Google Scholar
- 15.Prosper pharmaceutical wholesale pricelist 2004 [in Polish]. Warsaw: Prosper, 2004Google Scholar
- 16.Polish register of reimbursed pharmaceuticals II 2004 [in Polish]. Piotrków Trybunalski: Wydawnictwo JWC, 2004Google Scholar
- 18.Orlewska E, Mierzejewski P. Project of Polish guidelines for costing: methods and standard costs for pharmacoeconomic evaluations [in Polish]. Farmacoeconomika 2003; 1: 2–8Google Scholar
- 20.Gold M, Siegel J, Russell L, et al., editors. Cost-effectiveness in health and medicine. 1st ed. New York: Oxford University Press, 1996Google Scholar
- 22.National Institute for Health and Clinical Excellence. Guide to the methods of technology appraisal. London: National Institute for Health and Clinical Excellence, 2004 AprGoogle Scholar
- 23.Orlewska E. The cost-effectiveness of Arthrotec 75 versus diclofenac SR 75 in the treatment of rheumatoid arthritis and osteoarthritis in Poland [in Polish]. Farmakoekonomika 2000; 1: 2–18Google Scholar
- 24.World health report 2002. Geneva: World Health Organization, 2002Google Scholar
- 25.Macroeconomics and health: investing in health for economic development: report of the Commission on Macroeconomics and Health. Geneva: World Health Organization, 2001Google Scholar
- 26.The world health report 2002: Reducing risks, promoting healthy life. Geneva, World Health Organization[online]. Available from URL: http://www.who.int/whr/2002/en/ [Accessed 2008 Jun 23]
- 28.Drummond MF, O’Brien B, Stoddart GL, et al. Methods for the economic evaluation of health care programmes. 2nd ed. Oxford: Oxford University Press, 1997Google Scholar