title: Economic evaluation of irbesartan in combination with hydrochlorothiazide in the treatment of hypertension in Greece.
abstract: OBJECTIVE
  Hypertension is a major risk factor for cardiovascular disease and a leading cause of morbidity and mortality. This study evaluates irbesartan in relation to commonly used alternative hypertension therapies losartan and valsartan given in combination with hydrochlorothiazide (HCTZ) in the general hypertensive population in Greece.
  
  
  METHODS
  A Markov model with eight states of health was constructed: hypertension, myocardial infarction (MI), post-MI, angina, stroke, poststroke, heart failure, and death. The model has an annual cycle and estimates mean quality-adjusted survival and treatment cost, which reflect the hypertension treatment and managing cardiovascular events. Risk functions were used to conduct extrapolations. Data on treatment effectiveness, quality of life (QOL) and epidemiology were obtained from published clinical trials and studies. The database of the main Greek National Social Insurance Institute (IKA) was analyzed to estimate the cost of events. The analysis was done from a payer perspective. All outcomes were discounted, and prices correspond to 2008.
  
  
  RESULTS
  The estimated patient cost per annum was stable angina euro 2,252, unstable angina euro 2,572, myocardial infarction euro 2,473, post-MI euro 1,677, stroke euro 12,233, poststroke euro 1,240, heart failure euro 2,655, coronary angiography euro 1,544, percutaneous transluminal coronary angioplasty euro 6,511, and coronary artery bypass graft surgery euro 11,514. For the baseline group (age 57 years, systolic blood pressure 147 mmHg, cholesterol 6.00 mmol/L, body mass index 29) of men with mild to moderate hypertension, for irbesartan, the total treatment cost was euro 15,146, for losartan euro 15,696 and for valsartan euro 15,613; the quality-adjusted life years (QALYs) were irbesartan 12.67, losartan 12.63 and valsartan 12.64. For the baseline group of women with mild to moderate hypertension, the total treatment cost was euro 12,945 for irbesartan, euro 13,424 for losartan and euro 13,379 for valsartan; QALYs were 14.29 for irbesartan, 14.27 for losartan and 14.27 for valsartan. For men with severe hypertension, for irbesartan and losartan, the total treatment cost was euro 18,679 and euro 21,488 and QALYs 12.47 and 12.37, respectively. For women, the total treatment cost was euro 16,202 and euro 19,099 and QALYs 14.16 and 14.09, respectively. Similar results were obtained in relation to other treatment groups in various sensitivity analysis scenarios.
  
  
  CONCLUSIONS
  Based on efficacy data from clinical trials and lower attainment costs in various hypertensive patient populations, irbesartan in combination with HCTZ compares favorably with losartan and valsartan in combination with HCTZ in the Greek setting.
authors.affiliation: Department of Health Services Management, National School of Public Health, 196 Alexandras Avenue, 115 22, Athens, Greece. nmaniadakis@esdy.edu.gr
authors.forename: Nikos
authors.initials: N
authors.lastname: Maniadakis
authors.forename: Mattias
authors.initials: M
authors.lastname: Ekman
authors.forename: Vasilios
authors.initials: V
authors.lastname: Fragoulakis
authors.forename: Vasiliki
authors.initials: V
authors.lastname: Papagiannopoulou
authors.forename: John
authors.initials: J
authors.lastname: Yfantopoulos
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D057911:Angiotensin Receptor Antagonists / Q000191:economics* / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000191:economics* / Q000627:therapeutic use; D001713:Biphenyl Compounds / Q000191:economics* / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000150:complications; D002986:Clinical Trials as Topic; D003362:Cost-Benefit Analysis; D004338:Drug Combinations; D005260:Female; D006115:Greece; D006801:Humans; D006852:Hydrochlorothiazide / Q000191:economics* / Q000627:therapeutic use; D006973:Hypertension / Q000150:complications / Q000188:drug therapy*; D000077405:Irbesartan; D019808:Losartan / Q000191:economics / Q000627:therapeutic use; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D018803:Models, Economic; D011788:Quality of Life; D012737:Sex Factors; D013777:Tetrazoles / Q000191:economics* / Q000627:therapeutic use; D014633:Valine / Q000031:analogs & derivatives / Q000191:economics / Q000627:therapeutic use; D000068756:Valsartan
chemical_list: D057911:Angiotensin Receptor Antagonists; D000959:Antihypertensive Agents; D001713:Biphenyl Compounds; D004338:Drug Combinations; D013777:Tetrazoles; D006852:Hydrochlorothiazide; D000068756:Valsartan; D014633:Valine; D000077405:Irbesartan; D019808:Losartan
references.citation: Hypertension. 2002 Jan;39(1):105-10
references.pmid: 11799087
references.citation: Am Heart J. 1991 Mar;121(3 Pt 1):951-7
references.pmid: 2000773
references.citation: Med Care. 2001 Jun;39(6):599-615
references.pmid: 11404643
references.citation: Pharmacoeconomics. 2003;21(3):191-200
references.pmid: 12558469
references.citation: J Hypertens. 2005 Jul;23(7):1425-31
references.pmid: 15942467
references.citation: J Clin Hypertens (Greenwich). 2005 Oct;7(10):578-86
references.pmid: 16227760
references.citation: Nephrol Dial Transplant. 2005 Jun;20(6):1103-9
references.pmid: 15855214
references.citation: Eur J Neurol. 2006 Jun;13(6):581-98
references.pmid: 16796582
references.citation: Int J Clin Pract. 2007 Oct;61(10):1626-33
references.pmid: 17877649
references.citation: Int J Epidemiol. 2004 Dec;33(6):1345-52
references.pmid: 15218014
references.citation: J Clin Hypertens (Greenwich). 2004 Nov;6(11):614-20
references.pmid: 15538094
references.citation: Eur J Heart Fail. 2001 Jan;3(1):97-103
references.pmid: 11163742
references.citation: Qual Life Res. 2001;10(7):621-35
references.pmid: 11822795
references.citation: Pharmacoeconomics. 2006;24(6):549-58
references.pmid: 16761903
references.citation: J Hum Hypertens. 2006 Jan;20(1):51-8
references.pmid: 16357874
references.citation: Med Clin North Am. 1997 Sep;81(5):1077-97
references.pmid: 9308599
references.citation: J Int Med Res. 2005 Nov-Dec;33(6):620-31
references.pmid: 16372579
references.citation: Cardiovasc Drugs Ther. 2004 Sep;18(5):391-7
references.pmid: 15717142
references.citation: Curr Ther Res Clin Exp. 2005 Nov;66(6):475-85
references.pmid: 24678070
references.citation: Lancet. 2005 Jan 15-21;365(9455):217-23
references.pmid: 15652604
references.citation: J Hypertens. 2003 Nov;21(11):1983-92
references.pmid: 14597836
references.citation: Drugs. 2004;64(9):999-1028
references.pmid: 15101793
references.citation: J Clin Hypertens (Greenwich). 2006 Dec;8(12):850-7; quiz 858-9
references.pmid: 17170610
references.citation: Circulation. 2002 Dec 10;106(24):3068-72
references.pmid: 12473553
references.citation: Blood Press. 2005;14(2):107-13
references.pmid: 16036488
references.citation: Health Econ. 2000 Mar;9(2):149-58
references.pmid: 10721016
references.citation: Heart Fail Rev. 2000 Jun;5(2):167-73
references.pmid: 16228142
references.citation: Am J Hypertens. 2005 Nov;18(11):1482-8
references.pmid: 16280286
references.citation: Curr Med Res Opin. 2004 Nov;20(11):1691-1701
references.pmid: 15587481
references.citation: Clin Ther. 2007 May;29(5):963-971
references.pmid: 17697915
references.citation: Am J Hypertens. 2006 Aug;19(8):810-6; discussion 817
references.pmid: 16876679
references.citation: Am Heart J. 2000 Mar;139(3):371-7
references.pmid: 10689247
references.citation: Hellenic J Cardiol. 2007 Mar-Apr;48(2):55-63
references.pmid: 17489342
references.citation: Pharmacoeconomics. 2006;24(4):387-400
references.pmid: 16605284
references.citation: Eur Heart J. 2007 Jun;28(12):1462-536
references.pmid: 17562668
references.citation: Eur J Health Econ. 2007 Jun;8(2):161-8
references.pmid: 17237927
references.citation: Lancet. 2002 Nov 2;360(9343):1347-60
references.pmid: 12423980
references.citation: Curr Med Res Opin. 2006 Nov;22(11):2095-100
references.pmid: 17076969
references.citation: J Hum Hypertens. 2008 Dec;22(12):845-55
references.pmid: 18633426
references.citation: Am J Hypertens. 2006 Jan;19(1):53-60
references.pmid: 16461191
references.citation: Clin Ther. 2007 Jul;29(7):1508-23
references.pmid: 17825702