Cost eVectiveness of ramipril treatment for cardiovascular risk reduction

Objective—To assess the cost eVectiveness of ramipril treatment in patients at low, medium, and high risk of cardiovascular death. Design—Population based cost eVectiveness analysis from the perspective of the health care provider in the UK. EVectiveness was modelled using data from the HOPE (heart outcome prevention evaluation) trial. The life table method was used to predict mortality in a medium risk cohort, as in the HOPE trial (2.44% annual mortality), and in low and high risk groups (1% and 4.5% annual mortality, respectively). Setting—UK population using 1998 government actuary department data. Main outcome measure—Cost per life year gained at five years and lifetime treatment with ramipril. Results—Cost eVectiveness was £36 600, £13 600, and £4000 per life year gained at five years and £5300, £1900, and £100 per life year gained at 20 years (lifetime treatment) in low, medium, and high risk groups, respectively. Cost eVectiveness at 20 years remained well below that of haemodialysis (£25 000 per life year gained) over a range of potential drug costs and savings. Treatment of the HOPE population would cost the UK National Health Service (NHS) an additional £360 million but would prevent 12 000 deaths per annum. Conclusions—Ramipril is cost eVective treatment for cardiovascular risk reduction in patients at medium, high, and low pretreatment risk, with a cost eVectiveness comparable with the use of statins. Implementation of ramipril treatment in a medium risk population would result in a major reduction in cardiovascular deaths but would increase annual NHS spending by £360 million. (Heart 2001;85:539–543)