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PHARMACOEPIDEMIOLOGY

HOPE Study Impact on ACE Inhibitors Use

Drs Student, Graduate Department of Pharmacology, University of Toronto, Toronto, Ontario, Canada

Heather A Bennett

BSc Student, Graduate Department of Pharmaceutical Sciences, University of Toronto

Lori Bonari

BSc Student, Graduate Department of Pharmaceutical Sciences, University of Toronto

Donald Han

BSc Student, Graduate Department of Pharmaceutical Sciences, University of Toronto

Maria L Traverso

PhD Candidate, Area Farmacia Asistencial, Facultad de Ciencias Bioquímicas y Farmacéuticas, Universidad Nacional de Rosario, Rosario, Argentina

Thomas R Einarson, PhD

Professor, Graduate Department of Pharmaceutical Sciences, University of Toronto

Reprints: Michiel EH Hemels, The Hospital for Sick Children, Motherisk Program, 555 University Ave., Toronto, Ontario M5G 1X8, Canada, FAX 416/978-1833, E-mail m.hemels{at}utoronto.ca

BACKGROUND: Angiotensin-converting enzyme (ACE) inhibitors are used to treat cardiovascular diseases, major causes of death in Canada. The HOPE (Heart Outcomes Prevention Evaluation) study showed that ramipril benefits patients at high risk for cardiovascular disease. We analyzed ACE inhibitor use and costs in Canada before and after publication of HOPE.

METHODS: We obtained pharmacy and hospital sales data for 1985–2001 from IMS Canada for all ACE inhibitors (Anatomical Therapeutic Category code C09A0) and for the 3 largest provinces (i.e., British Columbia, Quebec, Ontario). Prescription numbers, total costs, cost/prescription, and market share of individual ACE inhibitors were plotted over time and analyzed using regression. Canadian dollars were used to report costs.

RESULTS: We examined 10 drugs; captopril was the first, introduced in 1985. Overall, prescriptions increased consistently from 356 000 in 1985 to 11.5 million in 2001, representing an annual increase of 660 000 (y = 661 410x–510 360; r² = 0.99). Total costs increased linearly from 1985 ($14.5 million) to 2001 ($513 million): Y = 29.3•10⁶x – 29.9•10⁶; r² = 0.99. Provincial utilization patterns were also similar. Ramipril's national use increased dramatically from 1999 (822 000 prescriptions, 9.2% of all ACE inhibitors) to 2001 (3.8 million, 32.8% of all ACE inhibitors). National costs for ramipril increased exponentially (y = 1.08e^0.6248x) to a total of $157 million in 2001, with the 3 major provinces accounting for 78.9%. Costs per prescription followed no observable trend (range $39.45–46.20).

CONCLUSIONS: The number of prescriptions and the total cost of ACE inhibitors increased over the period studied. Ramipril use increased in concert with publication of the HOPE trial, while the growth rates of other ACE inhibitors remained constant.

Key Words: ACE inhibitors, Canada, drug utilization, HOPE trial, ramipri

Published Online, April 2, 2003. www.theannals.com, DOI 10.1345/aph.1C339