The Cost-effectiveness of perindopril in reducing cardiovascular events in patients with stable coronary artery disease using data from the EUROPA Study

Andrew Briggs ^1*, Borislava Mihaylova ², Mark Sculpher ³, Alistair Hall ⁴, Jane Wolstenholme ¹, Maarten Simoons ⁵, Jaap Deckers ⁵, Ferrari Roberto ⁶, Willem J Remme ⁷, Michel Bertrand ⁸ and Kim Fox ⁹

¹ University of Glasgow, United Kingdom
² University of Oxford, United Kingdom
³ University of York, United Kingdom
⁴ University of Leeds, United Kingdom
⁵ Erasmus University Medical Centre, Netherlands
⁶ University of Ferrara, Italy
⁷ Sticares Cardiovascular Research Institute, Netherlands
⁸ Hopital Cardiologique de Lille, France
⁹ Royal Brompton Hospital, United Kingdom

^* To whom correspondence should be addressed. E-mail: a.briggs{at}clinmed.gla.ac.uk.

Accepted 26 September 2006

Abstract

Objectives The aim of this study is to assess the cost-effectiveness of perindopril in stable coronary heart disease in the UK

Background The European trial on Reduction Of cardiac events with Perindopril in stable coronary Artery disease (EUROPA) trial has recently reported.

Methods Clinical and resource use data were taken from the EUROPA trial. Costs included medications and hospitalisations. Health-related quality of life values were taken from external sources. Cost-effectiveness analysis is presented as a function of the risk of a primary event (non-fatal myocardial infarction, cardiac arrest or cardiovascular death) in order to identify individuals for whom treatment offers greatest value for money.

Results The median incremental cost per QALY gained of perindopril across the heterogeneous population of EUROPA was estimated as 9,700 GBP (inter-quartile range: 6,400 GBP - 14,200 GBP). Overall, 88% of the EUROPA population had an estimated cost per QALY below 20,000 GBP and 97% below 30,000 GBP. For a threshold value of cost-effectiveness of 30,000 GBP per QALY gained, individuals representing the 25th, 50th (median) and 75th percentiles of the cost-effectiveness distribution for perindopril have probabilities of 0.999, 0.99 and 0.93 of being cost-effective, respectively. Cost-effectiveness was strongly related to higher risk of a primary event under standard care.

Conclusions Whether the use of perindopril can be considered cost-effective depends on the health care systems' threshold value of cost-effectiveness. For the large majority of patients included in EUROPA, the incremental cost per QALY gained is lower than the apparent threshold used by the National Institute for Health and Clinical Excellence in the UK.

Keywords: Cost-effectiveness analysis, cardiovascular diseases, hypertension

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