William L. Baker, PharmD; Craig I. Coleman, PharmD; Jeffrey Kluger, MD; Kurt M. Reinhart, PharmD; Ripple Talati, PharmD; Robert Quercia, MS; Olivia J. Phung, PharmD; C. Michael White, PharmD
Disclaimer: The authors of this report are responsible for its content. Statements in the report should not be construed as endorsement by the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services.
Grant Support: By the University of Connecticut/Hartford Hospital Evidence-based Practice Center (contract 290-2007-10067-I) with the Agency for Healthcare Research and Quality.
Potential Conflicts of Interest: None disclosed.
Requests for Single Reprints: C. Michael White, PharmD, University of Connecticut/Hartford Hospital Evidence-based Practice Center, 80 Seymour Street, Hartford, CT 06102; e-mail, email@example.com.
Current Author Addresses: Drs. Baker, Coleman, Kluger, Reinhart, Talati, Phung, and White and Mr. Quercia: University of Connecticut/Hartford Hospital Evidence-based Practice Center, 80 Seymour Street, Hartford, CT 06102-5037.
Author Contributions: Conception and design: W.L. Baker, C.I. Coleman, J. Kluger, K.M. Reinhart, C.M. White.
Analysis and interpretation of the data: W.L. Baker, C.I. Coleman, K.M. Reinhart, R. Quercia, C.M. White.
Drafting of the article: W.L. Baker, C.I. Coleman, K.M. Reinhart, R. Talati, C.M. White.
Critical revision of the article for important intellectual content: W.L. Baker, C.I. Coleman, J. Kluger, C.M. White.
Final approval of the article: W.L. Baker, C.I. Coleman, J. Kluger, K.M. Reinhart, R. Talati, R. Quercia, O.J. Phung, C.M. White.
Statistical expertise: W.L. Baker, C.I. Coleman.
Obtaining of funding: W.L. Baker, C.I. Coleman, C.M. White.
Administrative, technical, or logistic support: W.L. Baker, R. Talati, R. Quercia, O.J. Phung.
Collection and assembly of data: W.L. Baker, C.I. Coleman, K.M. Reinhart, R. Talati, O.J. Phung.
Baker WL, Coleman CI, Kluger J, Reinhart KM, Talati R, Quercia R, et al. Systematic Review: Comparative Effectiveness of Angiotensin-Converting Enzyme Inhibitors or Angiotensin II–Receptor Blockers for Ischemic Heart Disease. Ann Intern Med. 2009;151:861-871. doi: 10.7326/0000605-200912150-00162
Download citation file:
Published: Ann Intern Med. 2009;151(12):861-871.
The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.
December 22, 2009
Effectiveness of therapeutic reviews in search for efficiency.
Effectiveness of therapeutic reviews and search for efficiency.
For patients with stable ischemic heart disease, Baker et al finally showed that adding an Angiotensin-Converting Enzyme Inhibitor (ACEI) to standard medical therapy decrease mortality and morbidity while there was less evidence supporting a benefit of Angiotensin Receptor Blockers (ARB) therapy (1). However, I have concern for the effectiveness of this review.
For hypertension, ONTARGET is one of many studies showing that both classes give the same benefits in outcome for mortality and morbidity (2). In contrast, there are huge differences for prices: eg. in France, a daily treatment with Captopril or its generics costs 0.33 euro vs 0.67 to 0.74 euro for ARB. Prices are not related to the social value of the product: cost-effectiveness analysis (ie efficiency) seems inexistent and far beyond the capabilities of national pricing committees. Conflicts of interest in medicine are the subject of intensive and extensive debates. These debates divert us from the sad reality. The data are available to every one but very few professionals, either experts or practitioners, have concern for price. Price which is paid by the most deprived, the patient. We know what is wrong, why are we so weak that we cannot adjust our behavior and take back control.
1 Baker WL, Coleman CI, Kluger J, et al. Systematic review: comparative effectiveness of angiotensin-converting enzyme inhibitors or angiotensin II-receptor blockers for ischemic heart disease.Ann Intern Med. 2009;151:861-71.
2 Yusuf S, Diener HC, Sacco RL, Cotton D, Ounpuu S, Lawton WA, et al. Telmisartan to Prevent Recurrent Stroke and Cardiovascular Events. N Eng J Med 2008;358:1547-59.
3 http://www.has-sante.fr/portail/upload/docs/application/pdf/2008- 10/fiche_iec_sartans_011008.pdf accessed Dec. 22, 2009
Cardiology, Nephrology, Hypertension, High Value Care, Coronary Risk Factors.
Copyright © 2016 American College of Physicians. All Rights Reserved.
Print ISSN: 0003-4819 | Online ISSN: 1539-3704
Conditions of Use
This PDF is available to Subscribers Only