Measurement of cost-effectiveness of drug therapy: a review of the treatment of hypertension.
There is good quantitative epidemiological evidence on the risk of cardiovascular disease posed by hypertension and, from large clinical trials, on the actual benefits gained from treatment of hypertension. Thus, hypertension presents a good model for the performance of cost-effectiveness analysis. From the Framingham study, it can be calculated that hypertensive men (blood pressure, greater than 160/95 mmHg) have a 2.8-fold higher cardiovascular mortality than normotensive men (blood pressure, less than 140/90 mmHg), and hypertensive women have a 2.3-fold higher incidence of cardiovascular mortality than normotensive women. Hypertension presents an equal relative risk to both men and women, but the absolute risk to men is greater. The largest absolute risk from hypertension is of coronary heart disease (144 events per 10,000 men per year); however, the largest relative risk from hypertension is of stroke (approximately 700%). From the Framingham data, it can be calculated that the complete reversal of hypertension for 18 years across a community could reduce the incidence of coronary heart disease by approximately 63%, and of strokes by 87%. Meta-analysis of the large clinical trials on the treatment of hypertension shows that mortality from stroke was reduced as a result of treatment by 38%, and that from coronary heart disease by 8%. Therefore the actual benefits of treatment, while significant, have not matched the theoretical benefits that could have been achieved. One of the reasons for this is that treatment may have adverse effects on other risk factors for coronary artery disease. All these factors, including the incidence of side effects interfering with quality of life, need to be taken into consideration when performing a cost-effectiveness analysis of the treatment of hypertension.
Moulds
R F
RF
Department of Clinical Pharmacology and Therapeutics, Royal Melbourne Hospital, Parkville, VIC.
D000368:Aged; D000959:Antihypertensive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D002561:Cerebrovascular Disorders / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D003327:Coronary Disease / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy* / Q000191:economics; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012307:Risk Factors
D000959:Antihypertensive Agents