Cost-effectiveness of lowering blood pressure with a fixed combination of perindopril and indapamide in type 2 diabetes mellitus: an ADVANCE trial-based analysis.
OBJECTIVE
To determine the cost-effectiveness of routine administration, irrespective of blood pressure (BP), of a fixed-dose combination of perindopril and indapamide to patients with type 2 diabetes mellitus.


METHODS
Prospective cost-effectiveness analysis within the Action in Diabetes and Vascular Disease: Preterax and Diamicron-MR Controlled Evaluation (ADVANCE) trial, an international, multicentre, randomised controlled trial of 11,140 participants with type 2 diabetes randomly allocated to receive perindopril plus indapamide (4 mg-1.25 mg/day) or placebo.


METHODS
Health-related quality-of-life measured by the EuroQol-5D, resource utilisation, and cost-effectiveness (cost per death averted at 4.3 years' average follow-up, and estimated cost per life-year gained, by extrapolation).


RESULTS
The mean health-related quality-of-life score of survivors was 0.80 (on a 0-1 scale [death to full health]), with no difference between treatment groups. Active treatment reduced hospital admissions for coronary heart disease and coronary revascularisation by 5%. For the Australian participants, perindopril-indapamide cost A$1368 per patient during the trial period, but reduced total hospitalisation costs by A$410 and other medication costs (mainly other BP-lowering drugs) by A$332. The absolute reduction in all-cause mortality for the active treatment group was 1.1%, giving a cost per life saved of A$49,200. Lifetime extrapolation gave an estimated cost per life-year saved of A$10,040 (discounted at 5% per year).


CONCLUSIONS
The combination of perindopril and indapamide in patients with type 2 diabetes appears to be cost-effective.


BACKGROUND
United States National Library of Medicine NCT00145925.
Glasziou
Paul P
PP
Clinical Epidemiology and Biostatistics, Bond University, Gold Coast, QLD, Australia. pglaszio@bond.edu.au
Clarke
Philip
P
Alexander
Jan
J
Rajmokan
Mohana
M
Beller
Elaine
E
Woodward
Mark
M
Chalmers
John
J
Poulter
Neil
N
Patel
Anushka
A
D000959:Antihypertensive Agents / Q000008:administration & dosage* / Q000191:economics; D001315:Australia; D001794:Blood Pressure / Q000187:drug effects; D003362:Cost-Benefit Analysis; D003925:Diabetic Angiopathies / Q000191:economics / Q000401:mortality / Q000517:prevention & control*; D017721:Hospital Costs; D006801:Humans; D006973:Hypertension / Q000191:economics / Q000517:prevention & control*; D007190:Indapamide / Q000008:administration & dosage* / Q000191:economics; D008017:Life Expectancy; D020913:Perindopril / Q000008:administration & dosage* / Q000191:economics; D011788:Quality of Life
D000959:Antihypertensive Agents; D007190:Indapamide; D020913:Perindopril