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The Lifetime Cost Effectiveness of Amlodipine-Based Therapy Plus Atorvastatin Compared with Atenolol Plus Atorvastatin, Amlodipine-Based Therapy Alone and Atenolol-Based Therapy Alone

Author

Listed:
  • Peter Lindgren
  • Martin Buxton
  • Thomas Kahan
  • Neil Poulter
  • Björn Dahlöf
  • Peter Sever
  • Hans Wedel
  • Bengt Jönsson

Abstract

Background: ASCOT (Anglo-Scandinavian Cardiac Outcomes Trial) showed in hypertensive patients that blood pressure-lowering treatment with an amlodipine-based regimen reduces events compared with an atenolol-based regimen and that atorvastatin was more effective than placebo. Objective: To assess the cost effectiveness of four alternative treatment strategies in patients with hypertension and three or more cardiovascular risk factors in the UK (from the UK NHS perspective) or Sweden (from the societal perspective): amlodipine-based plus atorvastatin, atenolol-based plus atorvastatin, amlodipine-based alone and atenolol-based alone. Methods: Based on the trial data, a Markov model was constructed where the risk of myocardial infarction, revascularization procedures and stroke and the long-term costs, quality of life and mortality associated with these events were estimated. Transition probabilities and costs (€, year 2007 values) were based on the patient-level trial data. Outcomes were reported as life-years gained and QALYs. In the latter case, utility reduction from events was based on a substudy in ASCOT patients. Treatment was applied for the duration of the lipid-lowering arm of the trial (3 years) and patients were then followed to the end of their life. Results: Amlodipine-based therapy plus atorvastatin was the most expensive but also most effective treatment. Compared with amlodipine-based therapy alone, the cost to gain one QALY was h11 965 in the UK and €8591 in Sweden. The incremental cost effectiveness of amlodipine-based therapy compared with atenolol-based therapy was €9548 and €3965 per QALY gained in the UK and Sweden, respectively. Atenolol-based therapy plus atorvastatin was eliminated through extended dominance. Conclusion: Applying the threshold values used by the National Institute for Health and Clinical Excellence (NICE) and the Swedish National Board of Health and Welfare, a combination of amlodipine-based therapy and atorvastatin appears to be cost effective in patients with hypertension and three or more additional risk factors. Copyright Adis Data Information BV 2009

Suggested Citation

  • Peter Lindgren & Martin Buxton & Thomas Kahan & Neil Poulter & Björn Dahlöf & Peter Sever & Hans Wedel & Bengt Jönsson, 2009. "The Lifetime Cost Effectiveness of Amlodipine-Based Therapy Plus Atorvastatin Compared with Atenolol Plus Atorvastatin, Amlodipine-Based Therapy Alone and Atenolol-Based Therapy Alone," PharmacoEconomics, Springer, vol. 27(3), pages 221-230, March.
    • Handle: RePEc:spr:pharme:v:27:y:2009:i:3:p:221-230
    DOI: 10.2165/00019053-200927030-00005
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    References listed on IDEAS

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    1. Peter Lindgren & Thomas Kahan & Neil Poulter & Martin Buxton & Patrick Svarvar & Björn Dahlöf & Bengt Jönsson, 2007. "Utility loss and indirect costs following cardiovascular events in hypertensive patients: the ASCOT health economic substudy," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 8(1), pages 25-30, March.
    2. David Meltzer, 1997. "Accounting for Future Costs in Medical Cost-Effectiveness Analysis," NBER Working Papers 5946, National Bureau of Economic Research, Inc.
    3. Frank A. Sonnenberg & J. Robert Beck, 1993. "Markov Models in Medical Decision Making," Medical Decision Making, , vol. 13(4), pages 322-338, December.
    4. Meltzer, David, 1997. "Accounting for future costs in medical cost-effectiveness analysis," Journal of Health Economics, Elsevier, vol. 16(1), pages 33-64, February.
    5. Magnus Johannesson & David Meltzer & Richard M. O'Conor, 1997. "Incorporating Future Costs in Medical Cost-Effectiveness Analysis," Medical Decision Making, , vol. 17(4), pages 382-389, October.
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