TY - JOUR
T1 - An economic evaluation of a perindopril-based blood pressure lowering regimen for patients who have suffered a cerebrovascular event
AU - Tavakoli, Manouchehr
AU - Pumford, Neil
AU - Woodward, Mark
AU - Doney, Alex
AU - Chalmers, John
AU - MacMahon, Stephen
AU - MacWalter, Ronald
N1 - Funding Information:
Neil Pumford was until recently an employee of Servier Laboratories (the manufacturer of Coversyl/perindopril and Natrilix/indapamide), Manouchehr Tavakoli has received a grant in relation to the economic modeling from Servier. John Chalmers and Stephem MacMahon have received grants from Servier as Chief Investigators for PROGRESS and ADVANCE administered in Sydney. John Chalmers, Stephen MacMahon, and Mark Woodward have all received honoraria from Servier for presentations regarding the studies at scientific meetings. Alex Doney received some financial support from Servier to attend the European Stroke Conference 2006. Ronald MacWalter has received honoraria from Servier for presentations and reimbursement for attending International symposia.
Funding Information:
This work was funded from an unrestricted research grant from Servier Laboratories Ltd (UK) and a program grant from the Australian National Health and Medical Research Council. We thank Sam Colman for statistical support from The George Institute, University of Sydney, Australia.
Funding Information:
An annual discount rate of 3.5% has been used for both costs and benefits [], as recommended by the UK Treasury and supported by the National Institute of Health and Clinical Excellence. Discounting is used to bring future costs and benefits into their equivalent present values for comparison purposes.
PY - 2009/2
Y1 - 2009/2
N2 - Objectives: Cerebrovascular disease (or stroke) is one of the main causes of long-term disability and the second leading cause of death worldwide. The economic impact of stroke is clearly seen, as it is the largest single cause of bed occupancy in hospitals in England and accounts for 6% of hospital costs. This analysis is the first to quantify the economic consequences of a blood pressure lowering regimen based on the PROGRESS study (perindopril-based regimen), for reducing future cardiovascular events. Design: A Markov decision analytical model was used to estimate the cost per quality adjusted life year (QALY) of blood pressure lowering in the treatment of patients presenting with a cerebrovascular event. The health states are based upon Barthel indices for which resource utilisation and health benefits have previously been estimated. Setting: The participants for the economic analysis were obtained from the PROGRESS study database. 6,105 clinical study participants were recruited through both primary and secondary care centres. Participants: The mean age was 64 years; 70% were male in the original study. Interventions: In the PROGRESS study, blood pressure lowering by a perindopril-based regimen was compared to standard care. Main outcome measures: Cost per quality adjusted life year for the duration of the study (4 years) and for a time span of 20 years. Results: Using only direct hospital medical costs, the cost per QALY for a perindopril based regimen is £6,927 for the base study period and £10,133 for a 20-year time period. These results are sensitive to the cost of perindopril, the cost of the stroke unit, length of stay, and to a lesser extent, the cost of indapamide. Conclusions: This analysis demonstrates a cost-effective treatment for patients suffering a cerebrovascular event with a blood pressure lowering regimen. The findings of this study are in line with current decisions and guidance by the national institute for health and clinical excellence (NICE) in England.
AB - Objectives: Cerebrovascular disease (or stroke) is one of the main causes of long-term disability and the second leading cause of death worldwide. The economic impact of stroke is clearly seen, as it is the largest single cause of bed occupancy in hospitals in England and accounts for 6% of hospital costs. This analysis is the first to quantify the economic consequences of a blood pressure lowering regimen based on the PROGRESS study (perindopril-based regimen), for reducing future cardiovascular events. Design: A Markov decision analytical model was used to estimate the cost per quality adjusted life year (QALY) of blood pressure lowering in the treatment of patients presenting with a cerebrovascular event. The health states are based upon Barthel indices for which resource utilisation and health benefits have previously been estimated. Setting: The participants for the economic analysis were obtained from the PROGRESS study database. 6,105 clinical study participants were recruited through both primary and secondary care centres. Participants: The mean age was 64 years; 70% were male in the original study. Interventions: In the PROGRESS study, blood pressure lowering by a perindopril-based regimen was compared to standard care. Main outcome measures: Cost per quality adjusted life year for the duration of the study (4 years) and for a time span of 20 years. Results: Using only direct hospital medical costs, the cost per QALY for a perindopril based regimen is £6,927 for the base study period and £10,133 for a 20-year time period. These results are sensitive to the cost of perindopril, the cost of the stroke unit, length of stay, and to a lesser extent, the cost of indapamide. Conclusions: This analysis demonstrates a cost-effective treatment for patients suffering a cerebrovascular event with a blood pressure lowering regimen. The findings of this study are in line with current decisions and guidance by the national institute for health and clinical excellence (NICE) in England.
KW - Blood pressure lowering
KW - Cerebrovascular
KW - Cost-effectiveness
KW - Markov
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U2 - 10.1007/s10198-008-0108-3
DO - 10.1007/s10198-008-0108-3
M3 - Article
C2 - 18446392
AN - SCOPUS:58149084017
SN - 1618-7598
VL - 10
SP - 111
EP - 119
JO - European Journal of Health Economics
JF - European Journal of Health Economics
IS - 1
ER -