Captopril in the management of patients after acute myocardial infarctions. A cost effectiveness analysis in Italy

The prevalence of acute myocardial infarction (AMI) is found in approximately 500,000 individuals in Italy. The annual incidence can be crudely estimated to be 100,000 events. This represents a major health care problem and generates questions about the rational allocation of public resources devoted to health care, specially since Italy has a National Health Service. We focused on the economics of adding captopril administration to standard care in Italy in AMI patients matching the entry criteria of the SAVE study. The cost effectiveness ratio(s) was explored under different assumptions on the effectiveness and on the cost of the intervention. In our base case, administering captopril has an incremental Cost Effectiveness Ratio of 14.708 million lira (1 US $ = 1529 lira in December 1996) per life year saved (LYS) (maximum range 7.171-21.003). This means that a net investment to the NHS of approximately 12 billion lira over 4 years to treat 10,000 patients matching the entry criteria of the SAVE trial will prevent 410 cardiovascular deaths (i.e. 33.229 million lira per cardiovascular death prevented) and save approximately 928 (discounted) to 1027 (not discounted) LYS over the same time period. Results are sensitive to the cost of captopril and of revascularisation procedures.