The cost-effectiveness of losartan versus captopril in patients with symptomatic heart failure

The Losartan Heart Failure ELITE Study recently found that in patients with symptomatic heart failure and a left ventricular ejection fraction of less than or equal to 0.40, losartan compared to captopril improved survival wi th better tolerability. The objective of this study was to perform an econo mic evaluation of losartan versus captopril based on the results of the Los artan Heart Failure ELITE Study. The Losartan Heart Failure ELITE Study was a multinational, double-blind, randomized 48-week study comparing the safe ty and efficacy of losartan to captopril in angiotensin-converting enzyme-i nhibitor-naive patients greater than or equal to 65 years with symptomatic heart failure. Data on health care resource utilization were collected as p art of the trial. We conducted a cost-effectiveness analysis to estimate th e lifetime benefits of treatment and the associated costs. We observed no d ifferences between treatments in the number of hospitalizations, hospital d ays, and emergency room visits per patient over the trial period. We estima ted the total cost of losartan to be USD 54 (95% CI: USD -1,717, USD 1,755) less per patient than captopril over this time frame. We also estimated th at over the projected remaining lifetime of the study population, losartan compared to captopril would increase survival by 0.20 years (undiscounted) at an average cost of USD 769 (discounted) more per patient. This cost incr ease translated into a cost-effectiveness ratio of USD 4,047 per year of li fe gained for losartan relative to captopril. In patients with symptomatic heart failure, losartan compared to captopril increased survival with bette r tolerability at a cost well within the range accepted as cost-effective.