Cost-effectiveness of different ACE inhibitor treatment scenarios in post-myocardial infarction

AIMS: To assess the cost-effectiveness of three different treatment strategies for the use of ACE inhibitors after myocardial infarction. These were (a) a high risk (AIRE type) strategy, (b) an intermediate risk (SAVE type) strategy, and (c) initial, short-term treatment of all patients followed by long-term treatment according to (a) or (b). METHODS AND RESULTS: Incremental costs per life year gained were calculated for each of the above scenarios. The most optimistic cost per life year gained over 10 years, for (a) was £1752 and for (b) was £2962. Strategy (c) increased the cost per life year gained of (a) to £2017 and (b) to £3110. The incremental cost-effectiveness ratio was found to be very sensitive to drug cost. CONCLUSIONS: If a low cost ACE inhibitor is used, initial treatment of relatively unselected patients followed by long-term treatment of those at high and medium risk maximizes benefit at an acceptable cost. Use of an ACE inhibitor after myocardial infarction is very cost-effective by comparison with many other treatments.