Cost-effectiveness Analyses of Antihypertensive Medicines: A Systematic Review

Overview

Journal Am J Prev Med

Specialty Public Health

Date 2017 Nov 21

PMID 29153114

Citations 22

Authors

Chanhyun Park

Guijing Wang

Jefferey M Durthaler

Jing Fang

Affiliations

Soon will be listed here.

Abstract

Context: Hypertension affects one third of the U.S. adult population. Although cost-effectiveness analyses of antihypertensive medicines have been published, a comprehensive systematic review across medicine classes is not available.

Evidence Acquisition: PubMed, Embase, Cochrane Library, and Health Technology Assessment were searched to identify original cost-effectiveness analyses published from 1990 through August 2016. Results were summarized by medicine class: angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), calcium channel blockers (CCBs), thiazide-type diuretics, β-blockers, and others. Incremental cost-effectiveness ratios (ICERs) were adjusted to 2015 U.S. dollars.

Evidence Synthesis: Among 76 studies reviewed, 14 compared medicines with no treatment, 16 compared medicines with conventional therapy, 29 compared between medicine classes, 13 compared within medicine class, and 11 compared combination therapies. All antihypertensives were cost effective compared with no treatment (ICER/quality-adjusted life year [QALY]=dominant-$19,945). ARBs were more cost effective than CCBs (ICER/QALY=dominant-$13,016) in nine comparisons, whereas CCBs were more cost effective than ARBs (ICER/QALY=dominant) in two comparisons. ARBs were more cost effective than ACEIs (ICER/QALY=dominant-$34,244) and β-blockers (ICER/QALY=$1,498-$18,137) in all eight comparisons.

Conclusions: All antihypertensives were cost effective compared with no treatment. ARBs appeared to be more cost effective than CCBs, ACEIs, and β-blockers. However, these latter findings should be interpreted with caution because these findings are not robust due to the substantial variability across the studies, including study settings and analytic models, changes in the cost of generic medicines, and publication bias.

Citing Articles

Flaxseed Lowers Blood Pressure in Hypertensive Subjects: A Meta-Analysis of Randomized Controlled Trials.

Moghadam E, Khaghani L, Shekarchizadeh-Esfahani P Clin Nutr Res. 2024; 13(4):295-306.

PMID: 39526211 PMC: 11543448. DOI: 10.7762/cnr.2024.13.4.295.

A Comprehensive Review on Nanoparticles as Drug Delivery System and Their Role for Management of Hypertension.

Prerna , Bhatt D, Mir K, Kumar V, Rathor S Curr Pharm Biotechnol. 2024; 26(2):169-185.

PMID: 38566387 DOI: 10.2174/0113892010291414240322112508.

Prevention-centered health care in Germany - a nation in need to turn the tide.

Baldus S, Lauterbach K Eur J Epidemiol. 2023; 38(8):835-837.

PMID: 37524897 PMC: 10421807. DOI: 10.1007/s10654-023-01030-3.

Health and Economic Impacts of Implementing Produce Prescription Programs for Diabetes in the United States: A Microsimulation Study.

Wang L, Lauren B, Hager K, Zhang F, Wong J, Kim D J Am Heart Assoc. 2023; 12(15):e029215.

PMID: 37417296 PMC: 10492976. DOI: 10.1161/JAHA.122.029215.

Editors' Commentary on the 2023 ESH Management of Arterial Hypertension Guidelines.

Whelton P, Flack J, Jennings G, Schutte A, Wang J, Touyz R Hypertension. 2023; 80(9):1795-1799.

PMID: 37354199 PMC: 10527435. DOI: 10.1161/HYPERTENSIONAHA.123.21592.

References

Merai R, Siegel C, Rakotz M, Basch P, Wright J, Wong B . CDC Grand Rounds: A Public Health Approach to Detect and Control Hypertension. MMWR Morb Mortal Wkly Rep. 2016; 65(45):1261-1264. DOI: 10.15585/mmwr.mm6545a3. View

Keynejad R, Semrau M, Toynbee M, Evans-Lacko S, Lund C, Gureje O . Building the capacity of policy-makers and planners to strengthen mental health systems in low- and middle-income countries: a systematic review. BMC Health Serv Res. 2016; 16(1):601. PMC: 5073499. DOI: 10.1186/s12913-016-1853-0. View

Whitehead S, Ali S . Health outcomes in economic evaluation: the QALY and utilities. Br Med Bull. 2010; 96:5-21. DOI: 10.1093/bmb/ldq033. View

Carter B, Ernst M, Cohen J . Hydrochlorothiazide versus chlorthalidone: evidence supporting their interchangeability. Hypertension. 2003; 43(1):4-9. DOI: 10.1161/01.HYP.0000103632.19915.0E. View

Weinstein M . Principles of cost-effective resource allocation in health care organizations. Int J Technol Assess Health Care. 1990; 6(1):93-103. DOI: 10.1017/s0266462300008953. View

Moher D, Liberati A, Tetzlaff J, Altman D . Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Int J Surg. 2010; 8(5):336-41. DOI: 10.1016/j.ijsu.2010.02.007. View

Ofman J, Sullivan S, Neumann P, Chiou C, Henning J, Wade S . Examining the value and quality of health economic analyses: implications of utilizing the QHES. J Manag Care Pharm. 2003; 9(1):53-61. PMC: 10437166. DOI: 10.18553/jmcp.2003.9.1.53. View

Godwin M, Ruhland L, Casson I, MacDonald S, Delva D, Birtwhistle R . Pragmatic controlled clinical trials in primary care: the struggle between external and internal validity. BMC Med Res Methodol. 2003; 3:28. PMC: 317298. DOI: 10.1186/1471-2288-3-28. View

. Vital signs: prevalence, treatment, and control of hypertension--United States, 1999-2002 and 2005-2008. MMWR Morb Mortal Wkly Rep. 2011; 60(4):103-8. View

10.

Danzon P, Furukawa M . International prices and availability of pharmaceuticals in 2005. Health Aff (Millwood). 2008; 27(1):221-33. DOI: 10.1377/hlthaff.27.1.221. View

11.

Huang Y, Zhou Q, Haaijer-Ruskamp F, Postma M . Economic evaluations of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers in type 2 diabetic nephropathy: a systematic review. BMC Nephrol. 2014; 15:15. PMC: 3913790. DOI: 10.1186/1471-2369-15-15. View

12.

Trogdon J, Finkelstein E, Nwaise I, Tangka F, Orenstein D . The economic burden of chronic cardiovascular disease for major insurers. Health Promot Pract. 2007; 8(3):234-42. DOI: 10.1177/1524839907303794. View

13.

Frogner B, Frech 3rd H, Parente S . Comparing efficiency of health systems across industrialized countries: a panel analysis. BMC Health Serv Res. 2015; 15:415. PMC: 4583987. DOI: 10.1186/s12913-015-1084-9. View

14.

Balu S, Thomas 3rd J . Incremental expenditure of treating hypertension in the United States. Am J Hypertens. 2006; 19(8):810-6. DOI: 10.1016/j.amjhyper.2005.12.013. View

15.

Lexchin J, Bero L, Djulbegovic B, Clark O . Pharmaceutical industry sponsorship and research outcome and quality: systematic review. BMJ. 2003; 326(7400):1167-70. PMC: 156458. DOI: 10.1136/bmj.326.7400.1167. View

16.

Kalra S, Kalra B, Agrawal N . Combination therapy in hypertension: An update. Diabetol Metab Syndr. 2010; 2(1):44. PMC: 2901246. DOI: 10.1186/1758-5996-2-44. View

17.

James P, Oparil S, Carter B, Cushman W, Dennison-Himmelfarb C, Handler J . 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2013; 311(5):507-20. DOI: 10.1001/jama.2013.284427. View

18.

Sanders G, Neumann P, Basu A, Brock D, Feeny D, Krahn M . Recommendations for Conduct, Methodological Practices, and Reporting of Cost-effectiveness Analyses: Second Panel on Cost-Effectiveness in Health and Medicine. JAMA. 2016; 316(10):1093-103. DOI: 10.1001/jama.2016.12195. View

19.

Gialama F, Maniadakis N . Comprehensive overview: efficacy, tolerability, and cost-effectiveness of irbesartan. Vasc Health Risk Manag. 2013; 9:575-92. PMC: 3794869. DOI: 10.2147/VHRM.S50831. View

20.

Bell C, Urbach D, Ray J, Bayoumi A, Rosen A, Greenberg D . Bias in published cost effectiveness studies: systematic review. BMJ. 2006; 332(7543):699-703. PMC: 1410902. DOI: 10.1136/bmj.38737.607558.80. View