title: Identification of factors driving differences in cost effectiveness of first-line pharmacological therapy for uncomplicated hypertension.
abstract: BACKGROUND
  Published practice guidelines and economic evaluations have come to different conclusions regarding optimal pharmacotherapy for the treatment of uncomplicated hypertension. The drivers of these disparities are not clear. Greater understanding is needed for clinicians, researchers and policy makers to determine the most effective and sustainable strategies.
  
  
  OBJECTIVE
  To identify how cost and cost-effectiveness considerations are used to generate recommendations by major hypertension guidelines, and determine key drivers of cost-effectiveness conclusions in available economic evaluations.
  
  
  METHODS
  A systematic search and narrative review of major hypertension guidelines and health technology assessments of first-line antihypertensive therapy were performed.
  
  
  RESULTS
  Of the eight guidelines identified, formal cost-effectiveness analysis was rarely integrated in the formulation of recommendations. When guidelines considered costs, recommendations remained incongruent. Two economic evaluations were identified (United Kingdom and Canada); however, these differed in their conclusion of the most cost-effective agent and attractiveness of calcium channel blockers. Review of these economic evaluations suggests that cost-effectiveness conclusions are strongly influenced by relative costs of drug classes; when relative differences in drug costs are lower, the impact on associated conditions such as heart failure and diabetes influences cost-effectiveness conclusions.
  
  
  CONCLUSIONS
  In the setting of finite health care resources and significant budget impact due to high population prevalence, cost effectiveness is an important consideration in the treatment of uncomplicated hypertension. Identification of key drivers of cost effectiveness will assist interpretation and conduct of current and future economic evaluations.
authors.affiliation: Department of Medicine, University of Alberta, Edmonton, Alberta. swk@ualberta.ca
authors.forename: Scott W
authors.initials: SW
authors.lastname: Klarenbach
authors.forename: Finlay A
authors.initials: FA
authors.lastname: McAlister
authors.forename: Helen
authors.initials: H
authors.lastname: Johansen
authors.forename: Karen
authors.initials: K
authors.lastname: Tu
authors.forename: Maureen
authors.initials: M
authors.lastname: Hazel
authors.forename: Robin
authors.initials: R
authors.lastname: Walker
authors.forename: Kelly B
authors.initials: KB
authors.lastname: Zarnke
authors.forename: Norman R C
authors.initials: NR
authors.lastname: Campbell
mesh_terms: D000959:Antihypertensive Agents / Q000191:economics* / Q000627:therapeutic use*; D002170:Canada; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics; D008297:Male; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D018570:Risk Assessment
chemical_list: D000959:Antihypertensive Agents