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Low doses vs. high doses of the angiotensin converting-enzyme inhibitor lisinopril in chronic heart failure: a cost-effectiveness analysis based on the Assessment of Treatment with Lisinopril and Survival (ATLAS) study. The ATLAS Study Group.

Publication ,  Journal Article
Sculpher, MJ; Poole, L; Cleland, J; Drummond, M; Armstrong, PW; Horowitz, JD; Massie, BM; Poole-Wilson, PA; Ryden, L
Published in: Eur J Heart Fail
December 2000

OBJECTIVE: A cost-effectiveness analysis of high and low doses of the angiotensin-converting enzyme (ACE) inhibitor lisinopril in the treatment of chronic heart failure. METHODS: A cost-effectiveness analysis using data from a randomized controlled trial, ATLAS, where 3164 patients with chronic heart failure were allocated to a high-dose (daily target dose 32.5-35 mg) or low-dose strategy (daily target dose 2.5-5.0 mg) of lisinopril. Differential costs were based on resource use data collected in the trial costed using UK unit costs. Cost-effectiveness analysis related differential costs to differential life-years during a 4-year trial follow-up. RESULTS: The mean total number of hospital in-patient days per patient was 18. 5 in the high dose group and 22.5 in the low dose group. Over the whole duration of the trial, the mean (S.D.) daily dose of lisinopril in the high-dose group was 22.5 mg (15.7 mg) compared to 3.2 mg (2.5 mg) in the low-dose group. The mean difference in cost per patient was pound sterling 397 lower in the high-dose group [95% CI (high-dose-low-dose) - pound sterling 1263 to pound sterling 436]. Mean life-years per patient were 0.085 years higher in the high-dose group [95% CI (high-dose-low-dose) -0.0074 to 0.1706). Based on mean costs and life-years, high-dose therapy dominates low-dose (less costly and more effective). Allowing for uncertainty in mean costs and life-years, the probability of high-dose therapy being less costly than low dose was 82%. If a decision maker is willing to pay at least pound sterling 3600 per life-year gained, the probability of high-dose being more cost-effective was 92%. CONCLUSIONS: The ATLAS Study showed that the treatment of heart failure with high-doses of lisinopril has a high probability of being more cost-effective than low-dose therapy.

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Published In

Eur J Heart Fail

DOI

ISSN

1388-9842

Publication Date

December 2000

Volume

2

Issue

4

Start / End Page

447 / 454

Location

England

Related Subject Headings

  • United Kingdom
  • Male
  • Lisinopril
  • Humans
  • Hospital Costs
  • Heart Failure
  • Health Resources
  • Female
  • Drug Costs
  • Double-Blind Method
 

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Sculpher, M. J., Poole, L., Cleland, J., Drummond, M., Armstrong, P. W., Horowitz, J. D., … Ryden, L. (2000). Low doses vs. high doses of the angiotensin converting-enzyme inhibitor lisinopril in chronic heart failure: a cost-effectiveness analysis based on the Assessment of Treatment with Lisinopril and Survival (ATLAS) study. The ATLAS Study Group. Eur J Heart Fail, 2(4), 447–454. https://doi.org/10.1016/s1388-9842(00)00122-7
Sculpher, M. J., L. Poole, J. Cleland, M. Drummond, P. W. Armstrong, J. D. Horowitz, B. M. Massie, P. A. Poole-Wilson, and L. Ryden. “Low doses vs. high doses of the angiotensin converting-enzyme inhibitor lisinopril in chronic heart failure: a cost-effectiveness analysis based on the Assessment of Treatment with Lisinopril and Survival (ATLAS) study. The ATLAS Study Group.Eur J Heart Fail 2, no. 4 (December 2000): 447–54. https://doi.org/10.1016/s1388-9842(00)00122-7.
Journal cover image

Published In

Eur J Heart Fail

DOI

ISSN

1388-9842

Publication Date

December 2000

Volume

2

Issue

4

Start / End Page

447 / 454

Location

England

Related Subject Headings

  • United Kingdom
  • Male
  • Lisinopril
  • Humans
  • Hospital Costs
  • Heart Failure
  • Health Resources
  • Female
  • Drug Costs
  • Double-Blind Method