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Cost-utility of angiotensin-converting enzyme inhibitor-based treatment compared with thiazide diuretic-based treatment for hypertension in elderly Australians considering diabetes as comorbidity.

Chowdhury EK, Ademi Z, Moss JR, Wing LM, Reid CM, Second Australian National Blood Pressure Study Management Committ - Medicine (Baltimore) (2015)

Bottom Line: 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.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.

View Article: PubMed Central - PubMed

Affiliation: 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.

ABSTRACT
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.

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Outline of the decision model for the cost-effectiveness analysis of ACEI-based treatment versus diuretic-based treatment of hypertension in an elderly population. ACEI = angiotensin-converting enzyme inhibitor, ANBP2 = Second Australian National Blood Pressure, Group A = hypertensive patients without preexisting diabetes at start, ICER = incremental cost-effectiveness ratio, QALY = quality-adjusted life-year.
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Figure 1: Outline of the decision model for the cost-effectiveness analysis of ACEI-based treatment versus diuretic-based treatment of hypertension in an elderly population. ACEI = angiotensin-converting enzyme inhibitor, ANBP2 = Second Australian National Blood Pressure, Group A = hypertensive patients without preexisting diabetes at start, ICER = incremental cost-effectiveness ratio, QALY = quality-adjusted life-year.

Mentions: We carried out a cost–utility analysis using patient-level data collected as part of the ANBP2 study to compare the 2 strategies: thiazide diuretic-based and ACEI-based treatments of hypertension. The perspective of the Australian government was taken into account while analyzing the data. The outcome of interest was the incremental cost-effectiveness ratio (ICER) in terms of AUD per quality-adjusted life-year (QALY) gained. The ANBP2 study provides real-life data on cardiovascular adverse events and new-onset diabetes in the elderly treated hypertensive population for the economic analysis. The decision model used for the economic analysis is illustrated in Figure 1. All costs are given in AUD (AUD 1–€ 0.65). The total patient population was stratified into 2 groups based on the presence of diabetes at baseline (randomization): group A participants were free from diabetes at baseline (n = 5642) and group B participants were known to have preexisting diabetes mellitus (type 1 or type 2) at baseline (n = 441). Both groups were followed on-treatment after being randomized for a median 4.1 years (maximum 5 years) until death or closeout of the study.


Cost-utility of angiotensin-converting enzyme inhibitor-based treatment compared with thiazide diuretic-based treatment for hypertension in elderly Australians considering diabetes as comorbidity.

Chowdhury EK, Ademi Z, Moss JR, Wing LM, Reid CM, Second Australian National Blood Pressure Study Management Committ - Medicine (Baltimore) (2015)

Outline of the decision model for the cost-effectiveness analysis of ACEI-based treatment versus diuretic-based treatment of hypertension in an elderly population. ACEI = angiotensin-converting enzyme inhibitor, ANBP2 = Second Australian National Blood Pressure, Group A = hypertensive patients without preexisting diabetes at start, ICER = incremental cost-effectiveness ratio, QALY = quality-adjusted life-year.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4553958&req=5

Figure 1: Outline of the decision model for the cost-effectiveness analysis of ACEI-based treatment versus diuretic-based treatment of hypertension in an elderly population. ACEI = angiotensin-converting enzyme inhibitor, ANBP2 = Second Australian National Blood Pressure, Group A = hypertensive patients without preexisting diabetes at start, ICER = incremental cost-effectiveness ratio, QALY = quality-adjusted life-year.
Mentions: We carried out a cost–utility analysis using patient-level data collected as part of the ANBP2 study to compare the 2 strategies: thiazide diuretic-based and ACEI-based treatments of hypertension. The perspective of the Australian government was taken into account while analyzing the data. The outcome of interest was the incremental cost-effectiveness ratio (ICER) in terms of AUD per quality-adjusted life-year (QALY) gained. The ANBP2 study provides real-life data on cardiovascular adverse events and new-onset diabetes in the elderly treated hypertensive population for the economic analysis. The decision model used for the economic analysis is illustrated in Figure 1. All costs are given in AUD (AUD 1–€ 0.65). The total patient population was stratified into 2 groups based on the presence of diabetes at baseline (randomization): group A participants were free from diabetes at baseline (n = 5642) and group B participants were known to have preexisting diabetes mellitus (type 1 or type 2) at baseline (n = 441). Both groups were followed on-treatment after being randomized for a median 4.1 years (maximum 5 years) until death or closeout of the study.

Bottom Line: 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.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.

View Article: PubMed Central - PubMed

Affiliation: 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.

ABSTRACT
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.

Show MeSH
Related in: MedlinePlus