The cost-effectiveness of the switch towards more expensive antihypertensive drugs.
A switch from treatment with diuretics and beta-blockers to treatment with the more expensive ACE-inhibitors and calcium-antagonists has been noted in the hypertension field. The aim of this paper was to analyse the cost-effectiveness of this switch towards more expensive antihypertensive drugs in Sweden. The upper limit of the cost-effectiveness of ACE-inhibitors and calcium-antagonists compared with diuretics and beta-blockers was estimated by assuming that ACE-inhibitors and calcium-antagonists achieve the epidemiologically expected risk reduction for coronary heart disease. The incremental cost per life-year gained varies between approximately SEK 50,000 and approximately SEK 6,000,000 ($1 = SEK 6) in the different patient groups analysed. It is concluded that ACE-inhibitors and calcium-antagonists may be potentially cost-effective in some patient groups at a high risk of coronary heart disease. Since an improved risk reduction has not been demonstrated in clinical trials, however, ACE-inhibitors and calcium-antagonists cannot at present be recommended for hypertension treatment in any patient groups unless treatment with diuretics and beta-blockers is contraindicated.
Centre for Health Economics, Stockholm School of Economics, Sweden.
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M
Johannesson
D000319:Adrenergic beta-Antagonists / Q000191:economics / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000191:economics* / Q000627:therapeutic use; D002121:Calcium Channel Blockers / Q000191:economics / Q000627:therapeutic use; D003362:Cost-Benefit Analysis / Q000706:statistics & numerical data; D003625:Data Collection; D016527:Drug Costs / Q000706:statistics & numerical data; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000191:economics* / Q000453:epidemiology; D011788:Quality of Life; D012307:Risk Factors; D013548:Sweden / Q000453:epidemiology; D026712:Value of Life