Cost Implications of Development of Diabetes in the ALPINE Study

Objective: To present a cost-effectiveness analysis of the Antihypertensive Treatment and Lipid Profile in a North of Sweden Efficacy Evaluation study (ALPINE).

Design: In newly diagnosed hypertensive individuals as yet untreated with drugs, the ALPINE study compared the 1-year metabolic effects of inexpensive treatment with a diuretic (hydrochlorothiazide), alone or in combination (84%) with a beta-adrenoceptor blocker (atenolol), with that of newer but also more expensive antihypertensive treatment with an angiotensin II receptor blocker (candesartan), alone or in combination (71%) with a calcium antagonist (felodipine). No crossover of medication was allowed. The cost-effectiveness analysis included costs for antihypertensive treatment during follow-up, and lifetime costs for care of diabetes mellitus diagnosed during follow-up. Cost per patient was calculated using Swedish prices and costs, translated into US dollars (US$), at 2004 prices.

Results: Diabetes mellitus was diagnosed in nine patients during the 1-year follow-up period of the study, eight in the hydrochlorothiazide group (4.1%) and one (0.5%) in the candesartan/felodipine group (P < 0.05). The cost of antihypertensive treatment per patient was US$92 in the hydrochlorothiazide/atenolol group and US$422 in the candesartan/felodipine group. Lifetime cost for care of diabetes mellitus per patient in the two groups was US$1013 and US$127, respectively. Total cost per patient was US$556 less in the candesartan/felodipine group. In sensitivity analyses, the outcome for the candesartan/felodipine group ranged from cost savings to an incremental cost of US$30 000 per case of diabetes mellitus prevented. In all analyses but one, the additional cost for antihypertensive treatment in the candesartan/felodipine group could be balanced by the reduced lifetime cost for care of diabetes mellitus.

Conclusions: The results suggest that an antihypertensive treatment strategy with candesartan and felodipine may have a favourable health economic impact in the longer term.