CAPTOPRIL IN THE MANAGEMENT OF PATIENTS AFTER ACUTE MYOCARDIAL INFARCTIONS - A COST-EFFECTIVENESS ANALYSIS IN ITALY

The prevalence of acute myocardial infarction (AMI) is found in approx imately 500 000 individuals in Italy. The annual incidence can be crud ely estimated to be 100 000 events. This represents a major health car e problem and generates questions about the rational allocation of pub lic resources devoted to health care, specially since Italy has a Nati onal Health Service. We focused on the economics of adding captopril a dministration to standard care in Italy in AMI patients matching the e ntry criteria of the SAVE study. The cost effectiveness ratio(s) was e xplored under different assumptions on the effectiveness and on the co st of the intervention. In our base case, administering captopril has an incremental Cost Effectiveness Ratio of 14.708 million Lira (1 US $ = 1529 lira in December 1996) per life year saved (LYS) (maximum rang e 7.171-21.003). This means that a net investment to the NHS of approx imately 12 billion lira over 4 years to treat 10 000 patients matching the entry criteria of the SAVE trial will prevent 410 cardiovascular deaths (i.e. 33.229 million lira per cardiovascular death prevented) a nd save approximately 928 (discounted) to 1027 (not discounted) LYS ov er the same time period. Results are sensitive to the cost of captopri l and of revascularisation procedures. (C) 1998 The Italian Pharmacolo gical Society.