AN ECONOMIC-ANALYSIS OF THE SURVIVAL AND VENTRICULAR ENLARGEMENT (SAVE) STUDY - APPLICATION TO THE UNITED-KINGDOM

Recent studies have shown that ACE inhibitors reduce morbidity and mor tality after myocardial infarction (MI). While these trials have obvio us clinical implications, the widespread introduction of a new treatme nt for a condition as common as MI also has clear cost implications. T he results uf the post-MI studies with ACE inhibitors suggest that res tricted use of treatment - in high-risk patients - is likely to be mos t cost effective, whereas treatment of all MI survivors, many of whom are at low risk, will be least cost effective. An approach somewhere i n between may maximise clinical benefit at an acceptable cost. Economi c analysis may help in deciding how these drugs might be best used aft er MI. We have conducted a cost-effectiveness and cost-utility analysi s of the Survival and Ventricular Enlargement (SAVE) study, which repo rted the benefit of ACE inhibitors in intermediate-risk patients. Assu ming all MI survivors require measurement of left ventricular function before selection for treatment (the approach used in the SAVE study), the incremental cost per life-year gained (LYG), over 4 years, using prophylactic captopril is approximately 10 000 pounds sterling (pound) [1994 to 1995 values]. The cost per quality-adjusted life-year (QALY) is similar. These incremental cost per LYG and cost per QALY ratios c ompare favourably with other commonly used symptomatic and prophylacti c treatments, and, argue for extending post-MI use of ACE inhibitors t o intermediate- as well as high-risk patients.