Michel B C, Al M J, Remme W J, Kingma J H, Kragten J A, van Nieuwenhuizen R, van Hout B A
Institute for Medical Technology Assessment, Erasmus University, Rotterdam, The Netherlands.
Eur Heart J. 1996 May;17(5):731-40. doi: 10.1093/oxfordjournals.eurheartj.a014940.
To estimate the costs and effects of preventive treatment with captopril compared with the current treatment policy in patients with asymptomatic left ventricular dysfunction after a myocardial infarction.
Estimates of effects are based on the results of the SAVE trial. Costs are estimated on the basis of current treatment patterns in four Dutch hospitals. All knowledge is incorporated in a mathematical model extrapolating the SAVE results to 20 years.
Captopril treatment is expected to increase survival at certain costs. The average additional costs per patient are estimated at DF1 2,491 in 4 years and at DF1 8,723 in 20 years of treatment. Costs per additional survivor after 4 years are estimated at DF1 69,126. After extrapolation of the results of the SAVE trial to 20 years, costs per life-year gained can be estimated at DF1 15,799. From univariate sensitivity analysis it appears that the results are highly sensitive for the costs of treatment with captopril and the occurrence and prevention of clinical heart failure. Varying all estimates randomly between upper and lower limits-in 5,000 simulations-an estimate of costs per life-year gained of DF1 15,729 is made for 20 years of treatment, with 95% of all estimates between DF10 and DF1 50, 000. On a national level, undiscounted costs are expected to increase up to approximately DF1 42 million annually during the first 40 years after introduction of the preventative strategy.
评估与心肌梗死后无症状左心室功能不全患者的当前治疗策略相比，卡托普利预防性治疗的成本和效果。
效果评估基于SAVE试验的结果。成本根据荷兰四家医院的当前治疗模式进行估算。所有知识均纳入一个将SAVE结果外推至20年的数学模型中。
卡托普利治疗有望以一定成本提高生存率。每位患者4年的平均额外成本估计为2491荷兰盾，20年治疗的平均额外成本估计为8723荷兰盾。4年后每增加一名幸存者的成本估计为69126荷兰盾。将SAVE试验结果外推至20年后，每获得一个生命年的成本估计为15799荷兰盾。单因素敏感性分析表明，结果对卡托普利治疗成本以及临床心力衰竭的发生和预防高度敏感。在5000次模拟中，将所有估计值在上下限之间随机变化，得出20年治疗每获得一个生命年的成本估计为15729荷兰盾，所有估计值的95%在10至50000荷兰盾之间。在国家层面，预计在引入预防策略后的头40年里，每年未贴现的成本将增加至约4200万荷兰盾。
