Economic Impact of Ramipril on Hospitalization of High-Risk Cardiovascular Patients

The incidence of cardiovascular disease in the US islarge. With respect to the type of cardiovascular event experienced by the population in 2001, approximately 7.3 million people have experienced a myocardial infarction (MI), 4.7 million have been diagnosed with or treated for congestive heart failure (CHF), and 4.5 million suffered a stroke.1,2 When consideration is given to the number of cardiovascular procedures performed in the US, in 1998 it was estimated that 539 000 percutaneous transluminal coro-nary angioplasties (PTCAs) were performed and that 336 000 patients underwent 553 000 coronary artery by-pass grafts (CABGs).1 The economic burden of cardiovascular disease is also enormous. The cost of treating a patient with cardiovascular disease can be quite variable, with the most important fac-tors including severity of the event, social factors, and clin-ical practice variations.3 An estimated $179.9 billion were spent in direct medical costs during 2001 on cardiovascu-lar disease and stroke (direct costs include physicians and other healthcare professionals, hospital and nursing home services, medications, home health care, other medical durable goods). When indirect costs such as lost productiv-ity resulting from morbidity and mortality are included, the total cost during 2001 was estimated at approximately $300 billion.1 A number of studies have established that angiotensin-converting enzyme (ACE) inhibitors can significantly re-duce morbidity and mortality in cardiovascular disease4-7 and related hospitalizations.5,8 ACE inhibitor therapy has demonstrated benefit in patients with low left-ventricular ejection fraction (LVEF <40).9 The efficacy of ramipril i