ECONOMIC-ASPECTS OF TREATMENT WITH CAPTOPRIL FOR PATIENTS WITH ASYMPTOMATIC LEFT-VENTRICULAR DYSFUNCTION IN THE NETHERLANDS

Objective To estimate the costs and effects of preventive treatment wi th captopril compared with the current treatment policy in patients wi th asymptomatic left ventricular dysfunction after a myocardial infarc tion. Methods Estimates of effects are based on the results of the SAV E trial. Costs are estimated on the basis of current treatment pattern s in four Dutch hospitals. All knowledge is incorporated in a mathemat ical model extrapolating the SAVE results to 20 years. Results and con clusions Captopril treatment is expected to increase survival at certa in costs. The average additional costs per patient are estimated at DF 1 2 491 in 4 years and at DF1 8 723 in 20 years of treatment. Costs pe r additional survivor after 4 years are estimated at DF1 69 126. After extrapolation of the results of the SAVE trial to 20 years, costs per life-year gained can be estimated at DF1 15 799. From univariate sens itivity analysis it appears that the results are highly sensitive for the costs of treatment with captopril and the occurrence and preventio n of clinical heart failure. Varying all estimates randomly between up per and lower limits - in 5000 simulations - an estimate of costs per life-year gained of DF1 15 729 is made for 20 years of treatment, with 95% of all estimates between DF1 0 and DF1 50 000. On a national leve l, undiscounted costs are expected to increase up to approximately DF1 42 million annually during the first 40 years after introduction of t he preventative strategy.