Economic evaluation of ASCOT-BPLA: antihypertensive treatment with an amlodipine-based regimen is cost effective compared with an atenolol-based regimen.
OBJECTIVE
To compare the cost effectiveness of an amlodipine-based strategy and an atenolol-based strategy in the treatment of hypertension in the UK and Sweden.


METHODS
A prospective, randomised trial complemented with a Markov model to assess long-term costs and health effects.


METHODS
Primary care.


METHODS
Patients with moderate hypertension and three or more additional risk factors.


METHODS
Amlodipine 5-10 mg with perindopril 4-8 mg added as needed or atenolol 50-100 mg with bendroflumethiazide 1.25-2.5 mg and potassium added as needed


METHODS
Cost per cardiovascular event and procedure avoided, and cost per quality-adjusted life-year gained.


RESULTS
In the UK, the cost to avoid one cardiovascular event or procedure would be euro18 965, and the cost to gain one quality-adjusted life-year would be euro21 875. The corresponding figures for Sweden were euro13 210 and euro16 856.


CONCLUSIONS
Compared with the thresholds applied by NICE and in the Swedish National Board of Health and Welfare's Guidelines for Cardiac Care, an amlodipine-based regimen is cost effective for the treatment of hypertension compared with an atenolol-based regimen in the population studied.
Lindgren
P
P
i3innovus, Vasagatan 38, 11120 Stockholm, Sweden; peter.lindgren@healtheconomics.se
Buxton
M
M
Kahan
T
T
Poulter
N R
NR
Dahlöf
B
B
Sever
P S
PS
Wedel
H
H
Jönsson
B
B
D000328:Adult; D000368:Aged; D017311:Amlodipine / Q000191:economics / Q000627:therapeutic use*; D000959:Antihypertensive Agents / Q000191:economics / Q000627:therapeutic use*; D001262:Atenolol / Q000191:economics / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D003925:Diabetic Angiopathies / Q000150:complications / Q000209:etiology / Q000401:mortality; D018572:Disease-Free Survival; D016527:Drug Costs; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000191:economics / Q000401:mortality; D017379:Hypertrophy, Left Ventricular / Q000150:complications; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000401:mortality; D016491:Peripheral Vascular Diseases / Q000150:complications; D011446:Prospective Studies; D019057:Quality-Adjusted Life Years; D012907:Smoking / Q000009:adverse effects; D020521:Stroke / Q000150:complications / Q000401:mortality
D000959:Antihypertensive Agents; D017311:Amlodipine; D001262:Atenolol