Assessment of the effect of ramipril therapy on direct health care costs for first and recurrent strokes in high-risk cardiovascular patients using data from the heart outcomes prevention evaluation (HOPE) study

Background: in the Heart Outcomes Prevention Evaluation (HOPE) Study, the angiotensin-converting enzyme (ACE) inhibitor ramipril was shown to significantly reduce the relative risk of stroke by 32% in high-risk cardiovascular patients (P < 0.001). However, the study did not examine the economic implications of these findings. Objective: The purpose of this economic analysis was to estimate the potential economic benefits of the differences in direct health care costs attributable to the prevention of first and recurrent strokes in the HOPE Study patient population through the use of ramipril. Methods: The epidemiologic component of the model examined the incidence of first and recurrent strokes in the HOPE Study population, assessed at annual increments, for the years 1995 through 1997. An economic decision model was constructed by the application of costs to the epidemiologic foundation. Direct costs for stroke hospitalization and follow-up were calculated based on estimates provided by Samsa et al (1999). The estimated cost of ramipril treatment was based on the average wholesale price for the corresponding year of the analysis. The Samsa index costs are given in 1991 US $; they were converted to study-year US $ using the Consumer Price Index for the corresponding year. Results: The mean age of the patient population was 69 years, with >70% of patients aged greater than or equal to65 years. When ACE-inhibitor treatment costs were included in the calculation of treatment costs, the expense to avert I stroke was estimated at $13,766 for years 1 to 2 after randomization and $12,281 for years 2 to 3. By years 3 to 4, ramipril treatment resulted in 21 fewer strokes and produced an estimated savings of $52,861. Conclusion: Ramipril 10 mg/d was a cost-effective means of preventing first and recurrent ischemic strokes in the HOPE Study patient population. Copyright (C) 2003 Excerpta Medica, Inc.