Cost-utility of angiotensin-converting enzyme inhibitor-based treatment compared with thiazide diuretic-based treatment for hypertension in elderly Australians considering diabetes as comorbidity.
The objective of this study was to examine the cost-effectiveness of angiotensin-converting enzyme inhibitor (ACEI)-based treatment compared with thiazide diuretic-based treatment for hypertension in elderly Australians considering diabetes as an outcome along with cardiovascular outcomes from the Australian government's perspective.We used a cost-utility analysis to estimate the incremental cost-effectiveness ratio (ICER) per quality-adjusted life-year (QALY) gained. Data on cardiovascular events and new onset of diabetes were used from the Second Australian National Blood Pressure Study, a randomized clinical trial comparing diuretic-based (hydrochlorothiazide) versus ACEI-based (enalapril) treatment in 6083 elderly (age ≥65 years) hypertensive patients over a median 4.1-year period. For this economic analysis, the total study population was stratified into 2 groups. Group A was restricted to participants diabetes free at baseline (n = 5642); group B was restricted to participants with preexisting diabetes mellitus (type 1 or type 2) at baseline (n = 441). Data on utility scores for different events were used from available published literatures; whereas, treatment and adverse event management costs were calculated from direct health care costs available from Australian government reimbursement data. Costs and QALYs were discounted at 5% per annum. One-way and probabilistic sensitivity analyses were performed to assess the uncertainty around utilities and cost data.After a treatment period of 5 years, for group A, the ICER was Australian dollars (AUD) 27,698 (&OV0556; 18,004; AUD 1-&OV0556; 0.65) per QALY gained comparing ACEI-based treatment with diuretic-based treatment (sensitive to the utility value for new-onset diabetes). In group B, ACEI-based treatment was a dominant strategy (both more effective and cost-saving). On probabilistic sensitivity analysis, the ICERs per QALY gained were always below AUD 50,000 for group B; whereas for group A, the probability of being below AUD 50,000 was 85%.Although the dispensed price of diuretic-based treatment of hypertension in the elderly is lower, upon considering the potential enhanced likelihood of the development of diabetes in addition to the costs of treating cardiovascular disease, ACEI-based treatment may be a more cost-effective strategy in this population.
From the Centre of Cardiovascular Research and Education in Therapeutics (EKC, ZA, CMR), Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia; Institute of Pharmaceutical Medicine (ZA), University of Basel, Basel, Switzerland; School of Population Health (JM), The University of Adelaide; and Department of Clinical Pharmacology (LMHW), School of Medicine, Flinders University, Adelaide, Australia.
Enayet K
EK
Chowdhury
Zanfina
Z
Ademi
John R
JR
Moss
Lindon M H
LMH
Wing
Christopher M
CM
Reid
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000191:economics* / Q000627:therapeutic use; D001315:Australia; D002318:Cardiovascular Diseases / Q000453:epidemiology; D015897:Comorbidity; D003362:Cost-Benefit Analysis; D003920:Diabetes Mellitus / Q000188:drug therapy / Q000453:epidemiology*; D005260:Female; D006760:Hospitalization; D006801:Humans; D006852:Hydrochlorothiazide / Q000191:economics / Q000627:therapeutic use; D006973:Hypertension / Q000188:drug therapy / Q000453:epidemiology*; D008297:Male; D019057:Quality-Adjusted Life Years; D012737:Sex Factors; D049993:Sodium Chloride Symporter Inhibitors / Q000191:economics* / Q000627:therapeutic use
D000806:Angiotensin-Converting Enzyme Inhibitors; D049993:Sodium Chloride Symporter Inhibitors; D006852:Hydrochlorothiazide