Economic impact of the reduced incidence of atrial fibrillation in patients with heart failure treated with enalapril.

BACKGROUND: Atrial fibrillation (AF) in the setting of heart failure (HF) is linked to embolic stroke and exacerbation of HF. The rate of new-onset AF in patients with left ventricular dysfunction and mild to moderate HF enrolled in the SoLVD trials was significantly lower with enalapril than with placebo (5.4% vs 24% over 2.9 years, P < .0001). The objective of this study was to predict economic benefits over 5 and 10 years of reduced AF incidence in patients receiving enalapril for the treatment of HF from a Canadian third-party payer perspective. METHODS: Consequences of reduced incidence of AF in enalapril-treated patients were modeled using a Markov model. Patients were assigned to 1 health state: no AF, AF, poststroke, or death, and moved from one state to the other according to published incidence rates. It was assumed that most patients with AF would receive warfarin for stroke prevention. Resource use and costs were mostly retrieved from published Canadian studies. RESULTS: Reduced incidence of AF resulted in savings of 382 dollars and 525 dollars per patient treated with enalapril over 5 and 10 years, respectively, which stemmed mainly from reduced AF hospitalization and less need for warfarin and amiodarone. Sensitivity analyses demonstrated that enalapril becomes more cost saving as the baseline risk for embolic stroke in patients with AF increases and the use of warfarin prophylaxis decreases. CONCLUSIONS: Reduced incidence of AF with enalapril leads to significant clinical and economic advantages on top of the already well-established benefits of enalapril for patients with HF.

An economic evaluation of rizatriptan in the treatment of migraine.

BACKGROUND: Migraine is a common, chronic, neurovascular disorder, generally characterised by attacks of severe headache and autonomic nervous system dysfunction. Triptans are selective serotonin 5-HT(1B/1D) receptor agonists that represent effective therapeutic options for moderate-to-severe migraine attacks but with higher acquisition costs relative to usual care therapies. OBJECTIVE: The objective of this study was to examine the cost effectiveness of rizatriptan treatment compared with 'Usual Care' or other triptans available in Canada for patients with moderate-to-severe migraine for whom other therapies (e.g. NSAIDs, simple analgesics) are insufficient or contraindicated. METHODS: A decision-analysis model was created to estimate migraine treatment costs over a 24-hour period in patients with a diagnosis of moderate-to-severe migraine as defined by the International Headache Society criteria. Costs and clinical outcomes were observed over a 24-hour period from therapy initiation. Efficacy measures consisted of 'pain-free response at 2 hours' and 'sustained pain free for 2-24 hours'. Oral rizatriptan 10 mg was compared with other oral triptans (i.e. sumatriptan 50 or 100 mg), naratriptan 2.5 mg and zolmitriptan 2.5 mg, based on a meta-analysis and compared with 'Usual Care' based on a naturalistic study of people who experience migraine and who were similar to the target population. 'Usual Care' was defined as an aggregate of medications prescribed for the Canadian population for the indication of migraine, weighted by the relative frequency of use of prescriptions over a 1-year period. Analyses were conducted from the Ontario (Canada) Ministry of Health and Long-Term Care (MOH