Efficacy and costs of treatment of mild-to-moderate uncomplicated hypertension in Greece

Abstract

The aim of this study was to compare the efficacy of the major classes of antihypertensive agents and the costs to prevent one death or one cardiovascular disease (CVD) event in patients with mild-to-moderate uncomplicated hypertension in Greece. A cost-effectiveness analysis was performed. A Markov model was developed to compare the five alternative interventions: chlorthalidone, propranolol, amlodipine, enalapril and losartan. The primary outcome measure was the 5-year NNT to prevent one death and the secondary outcome measure was the 5-year NNT to prevent one CVD event. Clinical inputs were derived from randomized controlled trials and cost data from public sources. The DerSimonian and Laird method was used for the meta-analysis. Only direct costs were considered in this analysis. All costs were calculated from the perspective of the public insurance system organisations, in 2004 Euros (). Future costs and clinical benefits were discounted at 5%. The time horizon was 5 years. Sensitivity analyses were performed. Old and new drugs provided similar protection against total mortality and major CVD events in mild-to-moderate uncomplicated hypertension. The 5-year NNT to prevent one death was 143 and just 34 patients had to receive one antihypertensive agent for five years to prevent one major CVD event. The estimated total cost to prevent one death was 60230.71, 70369.96, 105596.72, 75301.40 and 158659.35 for chlorthalidone, propranolol, amlodipine, enalapril and losartan respectively. The estimated total cost to prevent one CVD event was 14320.59, 16731.32, 25106.91, 17903.83 and 37723.20 respectively. In mild to moderate uncomplicated hypertension in Greece, chlorthalidone is the most cost-effective agent. The results of this analysis support the recommendations of the JNC-7 report.