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Cost effectiveness of antihypertensive drugs and treatment guidelines

Marta Kučan1, Igor Lulić2, Jasenka Mršić Pelčić3

  • 1Primorje-Gorski Kotar County Community Health Centre, Rijeka, Croatia. marta.kucan@ri.t-com.hr.

European Journal of Clinical Pharmacology
|June 2, 2021
PubMed

Insights

Diuretics, calcium channel blockers, and ACE inhibitors are cost-effective treatments for arterial hypertension, offering significant savings and improved quality-adjusted life years (QALYs). Diuretics are the most cost-effective first-line option, while beta-blockers are not recommended initially due to higher costs.

Area of Science:

  • Pharmacoeconomics
  • Cardiovascular Medicine
  • Health Economics

Background:

  • Arterial hypertension (AH) imposes a substantial economic burden on individuals and society.
  • Evaluating the cost-effectiveness of different antihypertensive drug classes is crucial for optimizing treatment strategies.

Purpose of the Study:

  • To compare the cost-effectiveness of four main classes of antihypertensives: diuretics (D), beta-blockers (B), angiotensin converting enzyme inhibitors/angiotensin-II receptor blockers (A), and calcium channel blockers (C).
  • To evaluate these treatments against a no intervention (NI) scenario.

Main Methods:

  • A Markov model was utilized, incorporating five health states.
  • Cost data, including drug acquisition, hospital, and general practice treatments, were sourced from the Croatian Health Insurance Fund.
  • Analysis was performed separately for 65-year-old men and women, considering baseline cardiovascular death and heart failure risks.

Main Results:

  • For men, diuretics yielded 0.76 QALYs and €886 savings; calcium channel blockers, 0.74 QALYs and €767 savings; ACE inhibitors/ARBs, 0.69 QALYs and €834 savings; beta-blockers, 0.40 QALYs and €41 additional cost.
  • For women, diuretics yielded 0.93 QALYs and €987 savings; calcium channel blockers, 0.89 QALYs and €855 savings; ACE inhibitors/ARBs, 0.86 QALYs and €991 savings; beta-blockers, 0.48 QALYs and €148 additional cost.

Conclusions:

  • Treatment with diuretics, calcium channel blockers, and ACE inhibitors/ARBs is cost-effective compared to no intervention for arterial hypertension.
  • Diuretics emerge as the most cost-effective first-line treatment option.
  • Beta-blockers, while increasing QALYs, incur additional costs and are not recommended as a primary first-line therapy based on this analysis.
Abstract

Keywords:
Antihypertensive drugsCost-effectiveness analysisTherapeutic guidelines

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