Cost-effectiveness analysis of captopril treatment after myocardial infarction

The recently published "Survival and Ventricular Enlargement" (SAVE), prospective controlled trial over 4 years including over 2,000 patients, has shown that long-term treatment with captopril reduced cardiovascular mortality (- 19%) and morbidity in patients with post-infarction left ventricular dysfunction without signs of cardiac failure. Based on the trial data, the extra cost of treating the patients with captopril compared with the placebo branch is estimated at 9.3 million french francs. This expense is compensated by a reduction in the cost of hospitalisation for cardiac failure of 1.6 million francs and a reduction in the cost of further coronary events of 3.4 million francs. Above all, the extra cost is compensated by a gain of 47 deaths avoided, corresponding to about 493.5 years of life saved. The cost-effectiveness of captopril administration is therefore about 8.750 francs per year per life saved. The ratio is significantly less than that of other primary or secondary prevention therapeutic strategies. On this basis, we conclude that captopril therapy of high risk post-infarction patients is a solution that is not only medically effective but also economically sound