COST-EFFECTIVENESS OF DIFFERENT ACE-INHIBITOR TREATMENT SCENARIOS POSTMYOCARDIAL INFARCTION

Aims To assess the cost-effectiveness of three different treatment str ategies for the use of ACE inhibitors after myocardial infarction. The se were (a) a high risk (AIRE type) strategy, (b) an intermediate risk (SAVE type) strategy, and (c) initial, short-term treatment of all pa tients followed by long-term treatment according to (a) or Cb). Method s and results Incremental costs per life year gained were calculated f or each of the above scenarios. The most optimistic cost per life year gained over IO years, for (a) was pound 1752 and for (b) was pound 29 62. Strategy (c) increased the cost per life year gained of(a) to poun d 2017 and (b) to pound 3310. The incremental cost-effectiveness ratio was found to be very sensitive to drug cost. Conclusions If a low cos t ACE inhibitor is used, initial treatment of relatively unselected pa tients followed by long-term treatment of those at high and medium ris k maximizes benefit at an acceptable cost. Use of an ACE inhibitor aft er myocardial infarction is very cost-effective by comparison with man y other treatments.