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Costs and Effects of Secondary Prevention with Perindopril in Stable Coronary Heart Disease in Poland

An Analysis of the EUROPA Study Including 1251 Polish Patients

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Abstract

Objectives: To estimate the long-term impact of treatment with perindopril on costs and health effects in patients with stable coronary artery disease in Poland.

Methods: The cost-effectiveness analysis was based on data from a randomized double-blind, placebo-controlled trial. A decision-tree analysis was employed, including Monte Carlo and bootstrapping techniques. This study was a sub-study of the EUROPA (European Trial on Reduction of Cardiac Events with Perindopril in Stable Coronary Artery Disease) trial (n = 12 218; mean follow-up 4.2 years). Resource use was based on data from Polish EUROPA study patients (n = 1251), while effectiveness was based on the whole EUROPA study. The health gain of perindopril in life-years was based on overall EUROPA study results, and the adapted Polish life expectancy of patients not dying during the trial. Costs were calculated in new Polish zloty (PLN), year 2003 values; €1 = PLN4.053. Only direct healthcare costs related to cardiovascular events and medication use were studied.

Results: When observed mortality was combined with life expectancy beyond the end of the study, perindopril use showed a gain in life expectancy of 0.182 lifeyears (SD ± 0.129) at a cost of PLN1983 (SD ± 103) with discounting of 5% per annum on costs and no discounting on effects. This resulted in an incremental cost-effectiveness ratio (ICER) of PLN10 896 per life-year gained. The probability that the ICER for perindopril was below the threshold of PLN60 000 was 88%. The overall results were insensitive to discount rates for costs and life-years.

Conclusions: Perindopril leads to a reduction in the risk of coronary events among patients with stable heart disease. When the expected improvement in life expectancy is combined with associated medical costs, there is a high probability that perindopril is cost effective, given the threshold of PLN60 000 per life-year gained.

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Acknowledgements

W. Ken Redekop, Louis Niessen and Frans F.H. Rutten designed the economic study. W. Ken Redekop carried out the analysis. Ewa Orlewska and Pawel Maciejewski designed and carried out the Polish costing study. All authors contributed to the writing of the manuscript. The authors acknowledge the efforts of Professor Witold Ruzyllo as national coordinator of the EUROPA study in Poland.

The authors have no conflicts of interest that are directly relevant to the content of this study. Financial support for this study was provided by Servier, France.

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Authors and Affiliations

  1. Institute for Medical Technology Assessment and Institute of Health Policy and Management, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands

    W. Ken Redekop & Louis W. Niessen

  2. Centre for Pharmacoeconomics, Warsaw, Poland

    Ewa Orlewska & Frans F. H. Rutten

  3. Department of Cardiology, Postgraduate Medical School Warsaw, Grochowski Hospital, Warsaw, Poland

    Pawel Maciejewski

  4. Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA

    Louis W. Niessen

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  1. W. Ken Redekop
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  2. Ewa Orlewska
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  3. Pawel Maciejewski
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  4. Frans F. H. Rutten
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  5. Louis W. Niessen
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Correspondence to W. Ken Redekop.

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Redekop, W.K., Orlewska, E., Maciejewski, P. et al. Costs and Effects of Secondary Prevention with Perindopril in Stable Coronary Heart Disease in Poland. Pharmacoeconomics 26, 861–877 (2008). https://doi.org/10.2165/00019053-200826100-00006

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