Low doses vs. high doses of the angiotensin converting-enzyme inhibitor lisinopril in chronic heart failure: a cost-effectiveness analysis based on the Assessment of Treatment with Lisinopril and Survival (ATLAS) study

被引:29
作者
Sculpher, MJ [1 ]
Poole, L
Cleland, J
Drummond, M
Armstrong, PW
Horowitz, JD
Massie, BM
Poole-Wilson, PA
Ryden, L
机构
[1] Univ York, Ctr Hlth Econ, York YO10 5DD, N Yorkshire, England
[2] AstraZeneca, Macclesfield, Cheshire, England
[3] Castle Hill Hosp, Dept Cardiol, Cottingham, England
[4] Univ Alberta, Dept Med, Edmonton, AB, Canada
[5] Univ Adelaide, Adelaide, SA, Australia
[6] Univ Calif San Francisco, San Francisco, CA 94143 USA
[7] Imperial Coll Sch Med, London, England
[8] Karolinska Inst, Stockholm, Sweden
关键词
cost-effectiveness; heart failure; angiotensin converting-enzyme inhibitor;
D O I
10.1016/S1388-9842(00)00122-7
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objective: A cost-effectiveness analysis of high and low doses of the angiotensin-converting enzyme (ACE) inhibitor lisinopril in the treatment of chronic heart failure. Methods: A cost-effectiveness analysis using data from a randomized controlled trial, ATLAS, where 3164 patients with chronic heart failure were allocated to a high-dose (daily target dose 32.5-35 mg) or low-dose strategy (daily target dose 2.5-5.0 mg) of lisinopril. Differential costs were based on resource use data collected in the trial costed using UK unit costs. Cost-effectiveness analysis related differential costs to differential life-years during a 4-year trial follow-up. Results: The mean total number of hospital in-patient days per patient was 18.5 in the high dose group and 22.5 in the low dose group. Over the whole duration of the trial, the mean (S.D.) daily dose of lisinopril in the high-dose group was 22.5 mg (15.7mg) compared to 3.2 mg (2.5 mg) in the low-dose group. The mean difference in cost per patient was pound 397 lower in the high-dose group [95% CI (high-dose-low-dose) -pound 1263 to pound 436]. Mean life-years per patient were 0.085 years higher in the high-dose group [95% CI (high-dose-low-dose) - 0.0074 to 0.1706). Based on mean costs and life-years, high-dose therapy dominates low-dose (less costly and more effective). Allowing for uncertainty in mean costs and life-years, the probability of high-dose therapy being less costly than low dose was 82%. If a decision maker is willing to pay at least pound 3600 per life-year gained, the probability of high-dose being more cost-effective was 92%. Conclusions: The ATLAS Study showed that the treatment of heart failure with high-doses of lisinopril has a high probability of being more cost-effective than low-dose therapy. (C) European Society of Cardiology. All rights reserved.
引用
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页码:447 / 454
页数:8
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