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The Economics of Trace

A Cost-Effectiveness Analysis of Trandolapril in Postinfarction Patients with Left Ventricular Dysfunction

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  • Economics of Trace
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Abstract

Objective: The objective of the study was to compute a cost-effectiveness ratio relating the economic cost of trandolapril to the number of effectiveness units (i.e. life-years) gained.

Design and Setting: The trandolapril cardiac evaluation (TRACE) study was a prospective placebo-controlled clinical trial designed to determine the long term effect of the oral angiotensin-converting enzyme (ACE) inhibitor trandolapril in postinfarction patients with left ventricular dysfunction. We used the individual data of the TRACE trial to compute a cost-effectiveness ratio relating the economic cost of trandolapril to the number of life-years saved. The analysis was differential and was conducted from a payer perspective in a French setting. Costs were computed from individual data related to the use of resources during the TRACE trial. For drug treatments, we chose French public prices, and for hospitalisations, we used the mean cost as determined by the diagnosis related group (DRG) from the 1996 Programme de Médicalisation des Systémes d’Information (PMSI) database from the French Ministry of Health. Life expectancy was estimated through an accelerated failure-time model with an exponential distribution specification; we made the conservative hypothesis that the effect of trandolapril on mortality after the end of the trial was nil. We assessed the standard deviation and the 95% confidence interval (CI) of the ratio through its bootstrap distribution.

Results: The incremental cost-effectiveness ratio of treating patients with trandolapril rather than with placebo was estimated as 4910 French francs (FF) per life-year saved. Discounting both costs and health effects led to a ratio of FF6950 per life-year saved. The bootstrap estimate of the ratio reached FF5950 and the 95% CI was FF5650 to FF6250 per life-year saved.

Conclusions: These results could be considered as highly cost effective, even though our estimation was very close to the design and the conditions of the TRACE trial. Nevertheless, we showed that this trial constitutes a favourable case for economic evaluation.

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References

  1. Eriksson H. Heart failure: a growing public health problem. J Intern Med 1995; 237: 135–41

    Article  PubMed  CAS  Google Scholar 

  2. Cleland JGF. Clinical perspective, ACE inhibitors for myocardialinfarction: how should they be used? Eur Heart J 1995; 16: 153–9

    PubMed  CAS  Google Scholar 

  3. Lindsay HSJ, Ball SG. ACE inhibitors in the treatment of myocardial infarction. Rev Contemp Pharmacother 1996; 7: 39–53

    Google Scholar 

  4. Salvetti A. Newer ACE inhibitors: a look at the future. Drugs 1990; 40 (6): 800–28

    Article  PubMed  CAS  Google Scholar 

  5. Ambrosioni E, Borghi C, Magnani B, et al. The effect of the angiotensin-converting-enzyme inhibitor zofenopril on mortality and morbidity after anterior myocardial infarction. N Engl J Med 1995; 332: 80–5

    Article  PubMed  CAS  Google Scholar 

  6. Gruppo Italiano per lo Studio della Soprawivenza nell’Infarto (GISSI) Miocardico. GISSI-3: effects of lisinopril and transdermal glyceryl trinitrate singly and together on 6-week mortality and ventricular function after myocardial infarction, Lancet 1994; 343: 1115–22

    Google Scholar 

  7. Fourth International Study of Infarct Survival (ISIS-4) Collaborative Group. ISIS-4: a randomized factorial trial assessing early oral captopril, oral mononitrate, and intravenous magnesium sulphate in 58050 patients with suspected myocardial infarction. Lancet 1995; 345: 669–85

    Article  Google Scholar 

  8. Pfeffer MA, Braunwald E, Moye LA, et al. Effect of captopril on mortality and morbidity in patients with left ventricular dysfunction after myocardial infarction: results of the Survival and Ventricular Enlargement Trial. N Engl J Med 1992; 327: 669–77

    Article  PubMed  CAS  Google Scholar 

  9. Cleland JGF, Erhardt L, Murray G, et al. Effect of ramipril on mortality and morbidity of survivors of acute myocardial infarction clinical evidence of heart failure. Lancet 1993; 342: 821–8

    Google Scholar 

  10. Køber L, Torp-Pederson C, Carlsen JE, et al. A clinical trial of the angiotensin-converting-enzyme inhibitor trandolapril in patients with left ventricular dysfunction after myocardial infarction. N Engl J Med 1995; 333: 1670–6

    Article  PubMed  Google Scholar 

  11. Giles T. The cost-effective forward for the management of the patient with heart failure. Cardiology 1996; 87 Suppl. 1: 33–9

    Article  Google Scholar 

  12. Kleber FX. Socioeconomic aspects of ACE inhibition in the secondary prevention in cardiovascular diseases. Am J Hypertens 1994; 7: 112S–6

    PubMed  CAS  Google Scholar 

  13. Kleber FX. The economics of cardiac failure. J R Soc Med 1996; 89: 9–12

    PubMed  CAS  Google Scholar 

  14. Kupersmith J, Holmes-Rovner M, Hogan A, et al. Cost-effectiveness analysis in heart disease. Part III: ischemia, congestive heart failure and arrhythmias. Cardiovasc Dis 1995; 37 (5): 307–46

    Article  CAS  Google Scholar 

  15. McMurray J, Davie A. The pharmacoeconomics of ACE inhibitors in chronic heart failure, Pharmacoeconomics 1996; 9 (3): 188–97

    Article  PubMed  CAS  Google Scholar 

  16. Paul SD, Kuntz KM, Eagle KA, et al. Costs and effectiveness of angiotensin converting enzyme inhibition in patients with congestive heart failure. Arch Intern Med 1994; 154: 1143–9

    Article  PubMed  CAS  Google Scholar 

  17. Scott WG, Scott HM. Heart failure: a decision analytic analysis of New Zealand data using the published results of the SOLVD treatment trial. Pharmacoeconomics 1996; 9 (2): 156–67

    Article  PubMed  CAS  Google Scholar 

  18. Tsevat J, Duke D, Goldman L, et al. Cost-effectiveness of captopril therapy after myocardial infarction. J Am Coll Cardiol 1996; 26 (4): 914–9

    Article  Google Scholar 

  19. Tsevat J, Pfeffer MA, Goldman L, et al. Economic aspects of captopril treatment. Eur Heart J 1997; 18: 165–9

    Article  PubMed  CAS  Google Scholar 

  20. Lindsay HSJ, Hall AS, Morris JL, et al. Strategies of ACE inhibitor following MI: costs and benefits [abstract]. Eur Heart J 1994; Suppl. 15: 328

    Google Scholar 

  21. Walsh JT, Gray D, Keating NA, et al. ACE for whom? Implications for clinical practice of post-infarct trials. Br Heart J 1995; 73: 470–4

    Article  PubMed  CAS  Google Scholar 

  22. Le Pen C, Levy F, Bonte J. L’analyse du coût—efficacité du traitement par captopril après infarctus du myocarde. Arch Mal Coeur Vaiss 1994; 87: 775–81

    PubMed  CAS  Google Scholar 

  23. Michel BC, Al MJ, Remme WJ, et al. Economic aspects of treatment with captopril for patients with asymptomatic left ventricular dysfunction in the Netherlands. Eur Heart J 1996; 17: 731–40

    Article  PubMed  CAS  Google Scholar 

  24. Szucs T, Berger K, Schulte-Hillen J, et al. The economic impact of captopril after myocardial infarction. Med Klin 1996; 91: 112–8

    CAS  Google Scholar 

  25. Drummond MF, O’Brien B, Stoddart GL, et al. Methods for the economic evaluation of health care programs. Oxford: Oxford Medical Publications, 1997

    Google Scholar 

  26. Beck JR, Kassirer JP, Pauker SG. A convenient approximation of life expectancy (‘The DEALE’). I: validation of the method. Am J Med 1982; 73 (6): 889–97

    Article  PubMed  CAS  Google Scholar 

  27. Weinstein MC, Siegel JE, Gold MR, et al. Recommendations of the Panel on Cost—Effectiveness in Health and Medicine. JAMA 1996; 276: 1253–8

    Article  PubMed  CAS  Google Scholar 

  28. Sloan F. Valuing health care. Cambridge: Cambridge University Press, 1996

    Google Scholar 

  29. Fisher LD. Biostatistics. New York: Wiley Interscience, 1993

    Google Scholar 

  30. Rutten-van Mölken MPMH, van Doorslaer, van Vliet RCJA, et al. Statistical analysis of cost outcomes in a randomized clinical trial. Health Econ 1994; 3: 169–88

    Article  Google Scholar 

  31. Tassi P. Máthodes statistiques. Paris: Economica, 1996

    Google Scholar 

  32. Mooney CZ, Duval RD. Bootstrapping: a non parametric approach to statistical inference. Thousand Oaks: Sage, 1993

    Google Scholar 

  33. Le Pen C, Levy P. Le coût des maladies cardiovasculaires. In: Grandjbakhch I, Ollivier JP, Pavie A, et al. La maladie coronaire: approches stratégiques et thérapeutiques. Paris: Arnette Blackwell, 1995

    Google Scholar 

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Authors and Affiliations

  1. LEGOS, University Paris-Dauphine, Paris, France

    Claude LePen

  2. CLP-Santé, 20 rue de Boulainvilliers, 75016, Paris, France

    Claude LePen & Hervé Lilliu

  3. Knoll AG, Ludwigshafen, Germany

    Thomas Keller

  4. HMR France, France, Romainville, France

    Sylvie Fiessinger

Authors
  1. Claude LePen
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  2. Hervé Lilliu
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  3. Thomas Keller
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  4. Sylvie Fiessinger
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Correspondence to Claude LePen.

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LePen, C., Lilliu, H., Keller, T. et al. The Economics of Trace. Pharmacoeconomics 14, 49–58 (1998). https://doi.org/10.2165/00019053-199814010-00005

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