Pharmacoeconomic analysis of antihypertensive agents in Greece

Abstract

The objective of this analysis was to estimate the direct costs associated with the prescription of various initial monotherapies for mild-to-moderate hypertension in Greece and the effect of modifying the input parameters on the economic endpoints. A cost-minimization analysis was performed from a third-party payer perspective, in 2004 Euros (). A Markov model was developed to compare the five alternative interventions: chlorthalidone, propranolol, amlodipine, enalapril and losartan. Clinical inputs were derived from randomized controlled trials and a meta-analysis and cost data from public sources. Only direct costs were considered in this analysis including the cost of drug therapy, monitoring, treating side-effects, poor compliance and switching. The time horizon was 5 years. Future costs and health benefits were discounted at 5%. The total cost to achieve and maintain hypertension control for five years of treatment was 485.87, 567.67, 851.83, 607.45 and 1279.88 for chlorthalidone, propranolol, amlodipine, enalapril and losartan respectively. The drug acquisition cost was 23.91%, 39.26%, 62.88%, 47.19% and 76.59% respectively. Drug acquisition cost and cost of laboratory monitoring were more than 85% of the total treatment cost for all the antihypertensive agents. Sensitivity analysis tested the effect of modifying the prices of the antihypertensive agents and laboratory monitoring, the doses of the alternative drugs and the compliance rate on the economic endpoints and confirmed the superiority of chlorthalidone. The management of mild-to-moderate uncomplicated hypertension in Greece with chlorthalidone cost less. If it was the drug of choice to initiate antihypertensive treatment, it would probably save the public insurance system organizations a great amount of expenses.