title: An economic assessment of losartan-based versus atenolol-based therapy in patients with hypertension and left-ventricular hypertrophy: results from the Losartan Intervention For Endpoint reduction (LIFE) study adapted to The Netherlands.
abstract: BACKGROUND
  The Losartan Intervention For Endpoint reduction (LIFE) study was a randomized, doubleblind trial that compared the effects of losartan-based treatment with those of atenolol-based treatment on cardiovascular disease (CVD)-related morbidity and mortality in 9193 patients with hypertension and left-ventricular hypertrophy (LVH). Compared with atenolol, losartan reduced the combined risk for CVD-related morbidity and mortality by 13% (P = 0.021), and reduced the risk for stroke by 25% (P = 0.001), with comparable blood pressure control in both trial arms.
  
  
  OBJECTIVE
  The aim of this study was to analyze the cost-effectiveness of losartan compared with atenolol in the treatment of stroke from the Dutch health care perspective.
  
  
  METHODS
  Utilization of losartan and atenolol within the trial period (mean, 4.8 years) and an estimation of direct medical costs of stroke for The Netherlands were combined with estimates of reduction in life expectancy through stroke. Medication costs and stroke incidence during 5.5 years of patient follow-up were estimated separately, adjusted for the baseline degree of LVH and Framingham risk score. To estimate lifetime stroke costs, the cumulative incidence of stroke was multiplied by the lifetime direct medical costs attributable to stroke. All costs are in 2006 Dutch prices and discounted following the former (4% costs and effects) and new Dutch guideline (4% costs, 1.5% effects) for conducting pharmacoeconomic analyses.
  
  
  RESULTS
  With 4% discounting, prevention of stroke was associated with a gain of 3.7 life-years. As a consequence, losartan treatment was associated with 0.059 life-year gained (LYG) per patient treated with losartan. Losartan reduced stroke-related costs by 1,076 Euros (US $1,349) per patient. After inclusion of study medication cost, net cost per patient was 51 Euros ($64) higher for losartan than atenolol. The net cost per LYG was 864 Euros ($1083), which is below the Dutch pharmacoeconomic threshold of 20,000 Euros/LYG (~$25,000/LYG) for accepting interventions. The corresponding probability of a cost-effectiveness ratio below this Dutch threshold was 0.95. Discounting money and health following the new Dutch guideline resulted in an even more favorable cost-effectiveness for losartan.
  
  
  CONCLUSIONS
  Results from the present analysis suggest that, in The Netherlands, treatment with losartan compared with atenolol may well be a cost-effective intervention based on the reduced risk for stroke observed in the LIFE trial.
authors: Groningen Research Institute of Pharmacy (GRIP), University of Groningen, Groningen, The Netherlands. Electronic address: c.boersma@rug.nl.
authors: Cornelis
authors: C
authors: Boersma
authors: Merck Research Laboratories, North Wales, Pennsylvania, USA.
authors: George W
authors: GW
authors: Carides
authors: Groningen Research Institute of Pharmacy (GRIP), University of Groningen, Groningen, The Netherlands.
authors: Jarir
authors: J
authors: Atthobari
authors: Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands.
authors: Adriaan A
authors: AA
authors: Voors
authors: Groningen Research Institute of Pharmacy (GRIP), University of Groningen, Groningen, The Netherlands.
authors: Maarten J
authors: MJ
authors: Postma
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000191:economics* / Q000627:therapeutic use*; D001262:Atenolol / Q000191:economics / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D002318:Cardiovascular Diseases / Q000191:economics / Q000453:epidemiology / Q000401:mortality; D003362:Cost-Benefit Analysis; D023381:Endpoint Determination; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy* / Q000191:economics; D017379:Hypertrophy, Left Ventricular / Q000150:complications*; D008017:Life Expectancy; D019808:Losartan / Q000191:economics* / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D012306:Risk; D020521:Stroke / Q000191:economics / Q000453:epidemiology / Q000401:mortality
chemical_list: D000959:Antihypertensive Agents; D001262:Atenolol; D019808:Losartan