Cost-effectiveness analysis of ramipril in heart failure after myocardial infarction - Economic evaluation of the Acute Infarction Ramipril Efficacy (AIRE) Study for Germany from the Perspective of Statutory Health Insurance

Objective: Data from the Acute Infarction Ramipril Efficacy (AIRE) study we re used in a cost-effectiveness analysis to determine the incremental cost per life-year gained (LYG) when the ACE inhibitor ramipril was added to con ventional treatment in patients with heart failure after acute myocardial i nfarction. In the AIRE trial, the addition of ramipril significantly lowere d rates of total mortality and rehospitalisation due to heart failure. Design and Setting: The cost-effectiveness analysis was conducted from the perspective of the Statutory Health Insurance (SHI) provider in Germany. A modelling approach was used which was based on secondary analysis of existi ng data, and costs were those incurred by SHI (i.e. expenses of SHI). In th e base-case analysis, average case-related expenses of SHI were applied and LYG were quantified by the method of Kaplan and Meier. Main outcome measures and results: The incremental cost-effectiveness ratio s of ramipril varied between 2500 and 8300 deutschmarks (DM) per LYG (1993 values for inpatient and 1995 values for outpatient treatment, DMI = $US0.7 0), according to the treatment periods of 3.8 years and 1 year, respectivel y. In the sensitivity analysis, the robustness of the model and its results was shown when the extent of influence of different model variables on the base-case results was investigated. First, survival probability and LYG we re estimated according to the Weibull method. Second, the dependency of the target variable (i.e. incremental cost per LYG) on random variables was de scribed in a simulation. Third, the influence of the model variables on the target variable was quantified using a deterministic model. The variance o f the target variable was broad and the hospitalisation impact of adding ra mipril to conventional treatment was an independent variable with much grea ter influence on the target variable than the parameter of clinical effecti veness, i.e. the number of LYG. Conclusion: Results of this evaluation showed that ramipril has a favourabl e incremental cost-effectiveness ratio for the treatment of heart failure i n post myocardial infarction patients and can be considered an economical t herapeutic agent from the perspective of SHI (third-party payer) in Germany .