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A comparison of the economic impact on the NHS of ramipril and enalapril in the treatment of essential hypertension.

Authors: JF Guest & VL Munro.
Source: British Journal of Medical Economics 1996; 10: 303-314.


An economic evaluation was undertaken to compare the economic differences to the National Health Service (NHS) of using either of the angiotensin-converting enzyme (ACE) inhibitors, ramipril or enalapril, to treat patients with essential hypertension. Since the two ACE inhibitors have been shown to exhibit similar clinical outcomes, a cost-minimisation analysis was undertaken on two groups of patients. First, patients already receiving antihypertensives and, secondly, those receiving either ramipril or enalapril as their first antihypertensive. The main outcome measures were NHS resources utilised in managing essential hypertension and costed at 1994/1995 prices.

The analysis showed that treating essential hypertension with antihypertensives other than ramipril or enalapril costs the NHS between £130 and £141 per patient annually. During the year in which ramipril or enalapril were first prescribed, resource utilisation and, therefore, costs associated with ACE inhibitor treatment increased. Changing patients’ antihypertensive regimens to include ramipril incurred a mean cost of £187 per patient during the first year of ACE inhibitor treatment. This compares with £261 per patient for enalapril. Patients taking ramipril utilised significantly fewer resources - particularly general practitioner consultations - which, together with ramipril’s lower acquisition cost, resulted in the cost-reduction.

There were no significant differences in resource utilisation between patients receiving ramipril and enalapril as their first antihypertensive. Using ramipril as the first-line antihypertensive costs the NHS £182 per patient for the first year of treatment, compared with £206 per patient for enalapril.

In conclusion, changing antihypertensive therapy to include ramipril, instead of enalapril, significantly reduces NHS resource utilisation during the first year of treatment. As a result, the NHS incurs lower direct healthcare costs for the management of essential hypertension.

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