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Type: Journal article
Title: 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
Author: Sculpher, M.
Poole, L.
Cleland, J.
Drummond, M.
Armstrong, P.
Horowitz, J.
Massie, B.
Poole-Wilson, P.
Ryden, L.
Citation: European Journal of Heart Failure, 2000; 20(2):447-454
Publisher: Elsevier Science BV
Issue Date: 2000
ISSN: 1388-9842
Statement of
Mark J. Sculpher, Lynne Poole, John Cleland, Michael Drummond, Paul W. Armstrong, John D. Horowitz, Barry M. Massie, Philip A. Poole-Wilson, Lars Ryden
Abstract: <h4>Objective</h4>A cost-effectiveness analysis of high and low doses of the angiotensin-converting enzyme (ACE) inhibitor lisinopril in the treatment of chronic heart failure.<h4>Methods</h4>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.<h4>Results</h4>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 (15.7 mg) compared to 3.2 mg (2.5 mg) in the low-dose group. The mean difference in cost per patient was pound sterling 397 lower in the high-dose group [95% CI (high-dose-low-dose) - pound sterling 1263 to pound sterling 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 sterling 3600 per life-year gained, the probability of high-dose being more cost-effective was 92%.<h4>Conclusions</h4>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.
Keywords: Cost-effectiveness
heart failure
angiotensin converting-enzyme inhibitor
Rights: © European Society of Cardiology. All rights reserved.
DOI: 10.1016/S1388-9842(00)00122-7
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