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Monday, October 20, 2008
Columbus A-C (Hyatt Regency Penns Landing)
Purpose
To estimate the net health benefit of available antihypertensives for choosing first-line, second-line and third-line antihypertensive treatment in primary prevention of cardiovascular disease.
Methods
We used the Norwegian Cardiovascular Disease model to estimate costs and life years gained from five antihypertensive drugs: ACE-inhibitors (ACE), angiotensine receptor blockers (ARB), beta blockers, calcium channel blockers (CCB) and thiazides. Effectiveness of these pharmaceuticals was taken from a recent systematic review while costs were taken from various country specific sources. Generic drugs and prices were used throughout. Adopting a willingness-to-pay threshold (λ) of $100,000, we calculated the expected net health benefit for the five antihypertensives to choose first line treatment, and then reanalysed to choose second-line treatment among the four remaining drugs, and finally reanalysed to choose third-line treatment among the three remaining drugs. Effectiveness of combined drug therapy was based on assumption about multiplicative effects. We performed probabilistic sensitivity analyses and constructed cost-effectiveness acceptability curves.
Results
For first-line therapy in primary prevention of cardiovascular disease, all five drugs were cost-saving in a majority of age and risk groups. All five drugs were cost-saving as first-line therapy, but CCB had the greatest net health benefit (NHB=0.9). CCB was also the drug with the highest probability of being cost-effective (40% of iterations in Monte Carlo simulations). Among the four remaining drugs, thiazides had the greatest NHB and would be the second drug if two pharmaceuticals were necessary. Even adding a third-line therapy would be cost effective. For third-line therapy, ARBs and beta blockers were the most cost-effective in different age and risk groups
Conclusion
Antihypertensive treatment with generic drugs is cost-effective and even cost-saving in a broad range of risk groups. CCB is likely the most cost-effective single-drug treatment, while CCB+thiazide are the most cost-effective two drug combination. The choice of third line treatment is more uncertain.
To estimate the net health benefit of available antihypertensives for choosing first-line, second-line and third-line antihypertensive treatment in primary prevention of cardiovascular disease.
Methods
We used the Norwegian Cardiovascular Disease model to estimate costs and life years gained from five antihypertensive drugs: ACE-inhibitors (ACE), angiotensine receptor blockers (ARB), beta blockers, calcium channel blockers (CCB) and thiazides. Effectiveness of these pharmaceuticals was taken from a recent systematic review while costs were taken from various country specific sources. Generic drugs and prices were used throughout. Adopting a willingness-to-pay threshold (λ) of $100,000, we calculated the expected net health benefit for the five antihypertensives to choose first line treatment, and then reanalysed to choose second-line treatment among the four remaining drugs, and finally reanalysed to choose third-line treatment among the three remaining drugs. Effectiveness of combined drug therapy was based on assumption about multiplicative effects. We performed probabilistic sensitivity analyses and constructed cost-effectiveness acceptability curves.
Results
For first-line therapy in primary prevention of cardiovascular disease, all five drugs were cost-saving in a majority of age and risk groups. All five drugs were cost-saving as first-line therapy, but CCB had the greatest net health benefit (NHB=0.9). CCB was also the drug with the highest probability of being cost-effective (40% of iterations in Monte Carlo simulations). Among the four remaining drugs, thiazides had the greatest NHB and would be the second drug if two pharmaceuticals were necessary. Even adding a third-line therapy would be cost effective. For third-line therapy, ARBs and beta blockers were the most cost-effective in different age and risk groups
Conclusion
Antihypertensive treatment with generic drugs is cost-effective and even cost-saving in a broad range of risk groups. CCB is likely the most cost-effective single-drug treatment, while CCB+thiazide are the most cost-effective two drug combination. The choice of third line treatment is more uncertain.
See more of: Poster Session II
See more of: 30th Annual Meeting of the Society for Medical Decision Making (October 19-22, 2008)