While we found relatively good st and ards of reporting the study ’s question , population , interventions , comparators and conclusions , the overall reporting was poor , and evidence of unfamiliarity with international guidelines was evident ( i.e. absence of incremental analysis , of discounting long-term costs and effects ) .
Analysis or description of place-to-place variability was infrequent .
Use and acceptance of health economic evaluations ( HEEs ) has been much greater in developed than in developing nations .
Nevertheless , while developing countries lag behind in the development of HEE methods , they could benefit from the progress made in other countries and concentrate on ways in which existing methods can be used or would need to be modified to fulfill their specific needs .
HEEs , as context -specific tools , are not easily generalizable from setting to setting .
Existing studies regarding generalizability and transferability of HEEs have primarily been conducted in developed countries .
Therefore , a legitimate question for policy makers in Latin America and the Caribbean region ( LAC ) is to what extent HEEs conducted in industrialized economies and in LAC are generalizable to LAC ( trans-regional ) and to other LAC countries ( intra-regional ) , respectively .
The Cost-Effectiveness of Losartan versus Captopril in Patients with Symptomatic Heart Failure
The Losartan Heart Failure ELITE Study recently found that in patients with symptomatic heart failure and a left ventricular ejection fraction of ≤0.40  , losartan compared to captopril  improved survival with better tolerability . The objective of this study was to perform an economic evaluation of losartan versus captopril based on the results of the Losartan Heart Failure ELITE Study . The Losartan Heart Failure ELITE Study was a multinational , double-blind , r and omized 48-week study comparing the safety and efficacy of losartan to captopril in angiotensin-converting enzyme-inhibitor-naive patients ≥65 years with symptomatic heart failure . Data on health care re source utilization were collected as part of the trial . We conducted a cost-effectiveness analysis to estimate the lifetime benefits of treatment and the associated costs . We observed no differences between treatments in the number of hospitalizations , hospital days , and emergency room visits per patient over the trial period . We estimated the total cost  of losartan to be USD 54 ( 95 % CI : USD –1,717 , USD 1,755 ) less per patient than captopril over this time frame . We also estimated that over the projected remaining lifetime of the study population , losartan compared to captopril would increase survival by 0.20 years ( undiscounted ) at an average cost of USD 769 ( discounted ) more per patient . This cost increase translated into a cost-effectiveness ratio of USD 4,047 per year of life gained for losartan relative to captopril . In patients with symptomatic heart failure , losartan compared to captopril  increased survival with better tolerability at a cost well within the range accepted as cost-effective
While we found relatively good st and ards of reporting the study ’s question , population , interventions , comparators and conclusions , the overall reporting was poor , and evidence of unfamiliarity with international guidelines was evident ( i.e. absence of incremental analysis , of discounting long-term costs and effects ) .
Analysis or description of place-to-place variability was infrequent .
Use and acceptance of health economic evaluations ( HEEs ) has been much greater in developed than in developing nations .
Nevertheless , while developing countries lag behind in the development of HEE methods , they could benefit from the progress made in other countries and concentrate on ways in which existing methods can be used or would need to be modified to fulfill their specific needs .
HEEs , as context -specific tools , are not easily generalizable from setting to setting .
Existing studies regarding generalizability and transferability of HEEs have primarily been conducted in developed countries .
Therefore , a legitimate question for policy makers in Latin America and the Caribbean region ( LAC ) is to what extent HEEs conducted in industrialized economies and in LAC are generalizable to LAC ( trans-regional ) and to other LAC countries ( intra-regional ) , respectively .