Cost-utility analysis of eprosartan compared to enalapril in primary prevention and nitrendipine in secondary prevention in Europe--the HEALTH model.
OBJECTIVE
To investigate the cost-utility of eprosartan versus enalapril (primary prevention) and versus nitrendipine (secondary prevention) on the basis of head-to-head evidence from randomized controlled trials.


METHODS
The HEALTH model (Health Economic Assessment of Life with Teveten for Hypertension) is an object-oriented probabilistic Monte Carlo simulation model. It combines a Framingham-based risk calculation with a systolic blood pressure approach to estimate the relative risk reduction of cardiovascular and cerebrovascular events based on recent meta-analyses. In secondary prevention, an additional risk reduction is modeled for eprosartan according to the results of the MOSES study ("Morbidity and Mortality after Stroke--Eprosartan Compared to Nitrendipine for Secondary Prevention"). Costs and utilities were derived from published estimates considering European country-specific health-care payer perspectives.


RESULTS
Comparing eprosartan to enalapril in a primary prevention setting the mean costs per quality adjusted life year (QALY) gained were highest in Germany (Euro 24,036) followed by Belgium (Euro 17,863), the UK (Euro 16,364), Norway (Euro 13,834), Sweden (Euro 11,691) and Spain (Euro 7918). In a secondary prevention setting (eprosartan vs. nitrendipine) the highest costs per QALY gained have been observed in Germany (Euro 9136) followed by the UK (Euro 6008), Norway (Euro 1695), Sweden (Euro 907), Spain (Euro -2054) and Belgium (Euro -5767).


CONCLUSIONS
Considering a Euro 30,000 willingness-to-pay threshold per QALY gained, eprosartan is cost-effective as compared to enalapril in primary prevention (patients >or=50 years old and a systolic blood pressure >or=160 mm Hg) and cost-effective as compared to nitrendipine in secondary prevention (all investigated patients).
Schwander
Björn
B
Analytica International, Lörrach, Germany.
Gradl
Birgit
B
Zöllner
York
Y
Lindgren
Peter
P
Diener
Hans-Christoph
HC
Lüders
Stephan
S
Schrader
Joachim
J
Villar
Fernando Antoñanzas
FA
Greiner
Wolfgang
W
Jönsson
Bengt
B
D000179:Acrylates / Q000191:economics* / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000191:economics* / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000188:drug therapy / Q000191:economics / Q000517:prevention & control; D003362:Cost-Benefit Analysis; D004656:Enalapril / Q000191:economics* / Q000627:therapeutic use; D005060:Europe; D005843:Geography; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000191:economics / Q000517:prevention & control; D007093:Imidazoles / Q000191:economics* / Q000627:therapeutic use; D008297:Male; D015201:Meta-Analysis as Topic; D008875:Middle Aged; D009010:Monte Carlo Method; D009568:Nitrendipine / Q000191:economics* / Q000627:therapeutic use; D011322:Primary Prevention / Q000191:economics / Q000379:methods; D019057:Quality-Adjusted Life Years; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment / Q000379:methods; D055502:Secondary Prevention / Q000191:economics / Q000379:methods; D020521:Stroke / Q000188:drug therapy / Q000191:economics / Q000517:prevention & control*; D013876:Thiophenes / Q000191:economics* / Q000627:therapeutic use
D000179:Acrylates; D000959:Antihypertensive Agents; D007093:Imidazoles; D013876:Thiophenes; C068373:eprosartan; D004656:Enalapril; D009568:Nitrendipine