Published Online
on February 3, 2003

A more recent version of this article appeared on February 25, 2003

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Submitted on September 5, 2002
Revised on November 7, 2002
Accepted on November 8, 2002

Cost Implications of the Use of Ramipril in High-Risk Patients Based on the Heart Outcomes Prevention Evaluation (HOPE) Study

Andre Lamy MD, MHSc^*, Salim Yusuf DPhil, Janice Pogue MSc, Amiram Gafni PhD, and on Behalf of the HOPE Investigators

From CADENCE Research Group (A.L.), Hamilton Health Sciences Corporation and Department of Surgery (A.L.), Department of Clinical Epidemiology and Biostatistics (A.L., S.Y., J.P., A.G.), Population Health Research Institute (A.L., S.Y., J.P., A.G.), Department of Cardiology (S.Y.), and Center for Health Economics and Policy Analysis (A.G.), McMaster University, Hamilton, Ontario, Canada.

^* To whom correspondence should be addressed. E-mail: lamya{at}mcmaster.ca.

Background--The HOPE study has demonstrated that ramipril is beneficial (ie, prevents cardiovascular death, myocardial infarction, and stroke) for a broad range of patients without evidence of left ventricular dysfunction or heart failure who are at high risk for cardiovascular event. In this study, we report the cost implications, in both the United States and Canada, of the use of ramipril after the HOPE study.

Methods and Results--A third-party perspective was chosen (Medicare for the United States and Ministry of Health for Canada). We calculated the costs of the management strategies of ramipril and placebo. An annual discount rate of 3% was used over the 4.5 years of follow-up. Sensitivity analyses were performed. Costs are reported in United States dollars and in Canadian dollars, respectively. The total costs per patient (including acquisition costs of ramipril) were not different between the groups in both countries (United States, $13 520 versus $13 631; Canada, $8702 versus $8588). From the distribution of cases in the bootstrap analysis, we found that 90% of cases fall either into a cost-neutral or cost-saving situation (64% in United States and 27% in Canada) or into a cost-effectiveness situation with an incremental cost-effectiveness ratio <$10 000 (in respective currency) per primary event saved.

Conclusions--On the basis of these results, we suggest that the use of ramipril is likely to represent an efficient use of resources in both countries. These findings support the use of ramipril in populations included in the HOPE study.

Key words: cardiovascular diseases • trials • cerebrovascular disorders • diabetes mellitus • cost-benefit analysis

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