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High- versus low-dose angiotensin converting enzyme inhibitor therapy in the treatment of heart failure: an economic analysis of the Assessment of Treatment with Lisinopril and Survival (ATLAS) trial.
Am J Manag Care. 2003 Jun; 9(6):417-24.AJ

Abstract

BACKGROUND

Angiotensin-converting enzyme (ACE) inhibitors reduce heart failure death and hospitalization. Prescribed doses often are lower than randomized clinical trial (RCT) targets and practice guideline recommendations.

OBJECTIVE

To assess the cost-effectiveness of high- versus low-dose ACE inhibitor therapy in the ATLAS trial.

STUDY DESIGN

A 19-nation RCT of high-dose (32.5-35.0 mg/day) versus low-dose (2.5-5.0 mg/day) lisinopril in 3164 patients with class II-IV heart failure and left ventricular ejection fraction < or = 30%.

METHODS

Data on clinical outcomes and major cost events (hospitalizations and drug utilization) were collected prospectively. Hospital costs were estimated using Medicare and representative managed care diagnosis-related group reimbursement rates. ACE inhibitor drug costs were estimated using US average wholesale prices. Costs were discounted at 3% annually.

RESULTS

Patients in the high-dose lisinopril group had fewer hospitalizations (1.98 vs 2.22, P = .014) and hospital days (18.28 vs 22.22, P = .002), especially heart failure hospitalizations (0.64 vs 0.80, P = .006) and heart failure hospital days (6.02 vs 7.45, P = .028) compared with the low-dose group. The high-dose lisinopril group also had lower heart failure hospital costs (dollars 5114 vs dollars 6361, P = .006) but higher ACE inhibitor drug costs (dollars 1368 vs dollars 855, P = .0001). Total hospital and drug costs were similar between high- and low-dose lisinopril groups (mean difference dollars -875, 95% CI dollars -2613 to dollars 884). Sensitivity analyses confirmed these findings.

CONCLUSIONS

Cost savings from fewer heart failure hospitalizations offset higher ACE inhibitor costs in the high-dose group. The improved clinical outcomes were achieved without increased treatment costs.

Authors+Show Affiliations

Department of Medicine, Leonard Davis Institute of Health Economics, Wharton School, Center for Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Comparative Study
Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

12816171

Citation

Schwartz, J Sanford, et al. "High- Versus Low-dose Angiotensin Converting Enzyme Inhibitor Therapy in the Treatment of Heart Failure: an Economic Analysis of the Assessment of Treatment With Lisinopril and Survival (ATLAS) Trial." The American Journal of Managed Care, vol. 9, no. 6, 2003, pp. 417-24.
Schwartz JS, Wang YR, Cleland JG, et al. High- versus low-dose angiotensin converting enzyme inhibitor therapy in the treatment of heart failure: an economic analysis of the Assessment of Treatment with Lisinopril and Survival (ATLAS) trial. Am J Manag Care. 2003;9(6):417-24.
Schwartz, J. S., Wang, Y. R., Cleland, J. G., Gao, L., Weiner, M., & Poole-Wilson, P. A. (2003). High- versus low-dose angiotensin converting enzyme inhibitor therapy in the treatment of heart failure: an economic analysis of the Assessment of Treatment with Lisinopril and Survival (ATLAS) trial. The American Journal of Managed Care, 9(6), 417-24.
Schwartz JS, et al. High- Versus Low-dose Angiotensin Converting Enzyme Inhibitor Therapy in the Treatment of Heart Failure: an Economic Analysis of the Assessment of Treatment With Lisinopril and Survival (ATLAS) Trial. Am J Manag Care. 2003;9(6):417-24. PubMed PMID: 12816171.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - High- versus low-dose angiotensin converting enzyme inhibitor therapy in the treatment of heart failure: an economic analysis of the Assessment of Treatment with Lisinopril and Survival (ATLAS) trial. AU - Schwartz,J Sanford, AU - Wang,Y Richard, AU - Cleland,John G F, AU - Gao,Longlong, AU - Weiner,Mark, AU - Poole-Wilson,Philip A, AU - ,, PY - 2003/6/21/pubmed PY - 2003/7/19/medline PY - 2003/6/21/entrez SP - 417 EP - 24 JF - The American journal of managed care JO - Am J Manag Care VL - 9 IS - 6 N2 - BACKGROUND: Angiotensin-converting enzyme (ACE) inhibitors reduce heart failure death and hospitalization. Prescribed doses often are lower than randomized clinical trial (RCT) targets and practice guideline recommendations. OBJECTIVE: To assess the cost-effectiveness of high- versus low-dose ACE inhibitor therapy in the ATLAS trial. STUDY DESIGN: A 19-nation RCT of high-dose (32.5-35.0 mg/day) versus low-dose (2.5-5.0 mg/day) lisinopril in 3164 patients with class II-IV heart failure and left ventricular ejection fraction < or = 30%. METHODS: Data on clinical outcomes and major cost events (hospitalizations and drug utilization) were collected prospectively. Hospital costs were estimated using Medicare and representative managed care diagnosis-related group reimbursement rates. ACE inhibitor drug costs were estimated using US average wholesale prices. Costs were discounted at 3% annually. RESULTS: Patients in the high-dose lisinopril group had fewer hospitalizations (1.98 vs 2.22, P = .014) and hospital days (18.28 vs 22.22, P = .002), especially heart failure hospitalizations (0.64 vs 0.80, P = .006) and heart failure hospital days (6.02 vs 7.45, P = .028) compared with the low-dose group. The high-dose lisinopril group also had lower heart failure hospital costs (dollars 5114 vs dollars 6361, P = .006) but higher ACE inhibitor drug costs (dollars 1368 vs dollars 855, P = .0001). Total hospital and drug costs were similar between high- and low-dose lisinopril groups (mean difference dollars -875, 95% CI dollars -2613 to dollars 884). Sensitivity analyses confirmed these findings. CONCLUSIONS: Cost savings from fewer heart failure hospitalizations offset higher ACE inhibitor costs in the high-dose group. The improved clinical outcomes were achieved without increased treatment costs. SN - 1088-0224 UR - https://www.unboundmedicine.com/medline/citation/12816171/High__versus_low_dose_angiotensin_converting_enzyme_inhibitor_therapy_in_the_treatment_of_heart_failure:_an_economic_analysis_of_the_Assessment_of_Treatment_with_Lisinopril_and_Survival__ATLAS__trial_ L2 - https://www.ajmc.com/pubMed.php?pii=8 DB - PRIME DP - Unbound Medicine ER -