Economic evaluation of telmisartan, valsartan and losartan in combination with hydrochlorothiazide for treatment of mild-to-moderate hypertension in Greece: a cost-utility analysis

Abstract

Objectives To evaluate the cost-utility of combined therapy of telmisartan with hydrochlorothiazide (HCTZ) compared to commonly used alternatives, losartan/HCTZ and valsartan/HCTZ, in patients with mild-to-moderate hypertension in Greece. Methods A Markov model was constructed from the third-party-payer perspective. The cycle length of the model was one year. Risk equations derived from the HellenicSCORE and Framingham Heart Study were used to estimate transition probabilities between states. Treatment effectiveness and utility values were obtained from published clinical trials and studies. Costs assigned to each health state were obtained from real data and reflected the years 2012. Key findings The model predicted that discounted quality-adjusted life-years (QALYs) were higher in the telmisartan/HCTZ group compared to losartan/HCTZ group by 0.09 and 0.03 in men and women, respectively. Moreover, telmisartan/HCTZ was found to be related to higher total lifetime costs per patient than losartan/HCTZ by €98 and €276 in men and women, respectively. Similarly, the comparison between telmisartan/HCTZ and valsartan/HCTZ revealed that the former is more effective (QALYs, gained 0.12 and 0.04, in men and women, respectively) and more costly by €536 and €780 in men and women, respectively. Based upon a willingness-to-pay threshold of €30 000 per QALY gained, telmisartan/HCTZ was found to be cost-effective as the incremental cost-effectiveness ratios were estimated at €3002 and €4806 per QALY gained in men and €10 856 and €25 837 in women. Conclusion The analysis revealed that telmisartan/HCTZ may be a cost effective alternative to generic losartan/HCTZ and valsartan/HTCZ for treatment of mild-to-moderate hypertension in the Greek setting.