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BMC Cardiovascular Disorders
Published in: BMC Cardiovascular Disorders 1/2012

Open Access 01-12-2012 | Research article

Choice of generic antihypertensive drugs for the primary prevention of cardiovascular disease - A cost-effectiveness analysis

Authors: Torbjørn Wisløff, Randi M Selmer, Sigrun Halvorsen, Atle Fretheim, Ole F Norheim, Ivar Sønbø Kristiansen

Published in: BMC Cardiovascular Disorders | Issue 1/2012

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Abstract

Background

Hypertension is one of the leading causes of cardiovascular disease (CVD). A range of antihypertensive drugs exists, and their prices vary widely mainly due to patent rights. The objective of this study was to explore the cost-effectiveness of different generic antihypertensive drugs as first, second and third choice for primary prevention of cardiovascular disease.

Methods

We used the Norwegian Cardiovascular Disease model (NorCaD) to simulate the cardiovascular life of patients from hypertension without symptoms until they were all dead or 100 years old. The risk of CVD events and costs were based on recent Norwegian sources.

Results

In single-drug treatment, all antihypertensives are cost-effective compared to no drug treatment. In the base-case analysis, the first, second and third choice of antihypertensive were calcium channel blocker, thiazide and angiotensin-converting enzyme inhibitor. However the sensitivity and scenario analyses indicated considerable uncertainty in that angiotensin receptor blockers as well as, angiotensin-converting enzyme inhibitors, beta blockers and thiazides could be the most cost-effective antihypertensive drugs.

Conclusions

Generic antihypertensives are cost-effective in a wide range of risk groups. There is considerable uncertainty, however, regarding which drug is the most cost-effective.
Appendix
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Literature
1.
World Health Organization: The World Health Report 2002: reducing risks, promoting healthy life. Geneva. 2002
2.
Håheim LL, Fretheim A, Brørs O, Kjeldsen SE, Kristiansen IS, Madsen S, Njølstad I, Norheim OF, Ose L, Svilaas A, et al: Primærforebygging av hjerte- og karsykdom, med hovedvekt på medikamentelle tiltak. 2008
3.
Williams B: Recent hypertension trials: implications and controversies. J Am Coll Cardiol. 2005, 45: 813-827. 10.1016/j.jacc.2004.10.069.CrossRefPubMed
4.
Kaplan NM, Opie LH: Controversies in hypertension. Lancet. 2006, 367: 168-176. 10.1016/S0140-6736(06)67965-8.CrossRefPubMed
5.
McCabe C, Claxton K, Culyer AJ: The NICE cost-effectiveness threshold: what it is and what that means. Pharmacoeconomics. 2008, 26: 733-744. 10.2165/00019053-200826090-00004.CrossRefPubMed
6.
Wisløff T, Norheim OF, Halvorsen S, Selmer R, Kristiansen IS: Kostnader og leveårsgevinster ved medikamentell primærforebygging av hjertekarsykdom. 2008
7.
Wisløff T, Selmer R, Halvorsen S, Kristiansen IS: Norwegian Cardiovascular Disease model (NorCaD). Oslo. 2008
8.
9.
10.
Ellekjaer H, Holmen J, Indredavik B, Terent A: Epidemiology of stroke in Innherred, Norway, 1994 to 1996. Incidence and 30-day case-fatality rate. Stroke. 1997, 28: 2180-2184. 10.1161/01.STR.28.11.2180.CrossRefPubMed
11.
Daly C, Clemens F, Lopez Sendon JL, Tavazzi L, Boersma E, Danchin N, Delahaye F, Gitt A, Julian D, Mulcahy D, et al: Gender differences in the management and clinical outcome of stable angina. Circulation. 2006, 113: 490-498. 10.1161/CIRCULATIONAHA.105.561647.CrossRefPubMed
12.
Hasdai D, Behar S, Wallentin L, Danchin N, Gitt AK, Boersma E, Fioretti PM, Simoons ML, Battler A: A prospective survey of the characteristics, treatments and outcomes of patients with acute coronary syndromes in Europe and the Mediterranean basin; the Euro Heart Survey of Acute Coronary Syndromes (Euro Heart Survey ACS). Eur Heart J. 2002, 23: 1190-1201. 10.1053/euhj.2002.3193.CrossRefPubMed
13.
Follath F: Causes of acute heart failure: Acute de novo verus decompensated chronic heart failure. Presentation at ESC congress 2005 Stockholm. 2005
14.
Rosolova H, Cech J, Simon J, Spinar J, Jandova R, Widimsky sJ, Holubec L, Topolcan O: Short to long term mortality of patients hospitalised with heart failure in the Czech Republic--a report from the EuroHeart Failure Survey. Eur J Heart Fail. 2005, 7: 780-783. 10.1016/j.ejheart.2005.03.009.CrossRefPubMed
15.
Cleland JG, Swedberg K, Follath F, Komajda M, Cohen-Solal A, Aguilar JC, Dietz R, Gavazzi A, Hobbs R, Korewicki J, et al: The EuroHeart Failure survey programme-- a survey on the quality of care among patients with heart failure in Europe. Part 1: patient characteristics and diagnosis. Eur Heart J. 2003, 24: 442-463.CrossRefPubMed
16.
Fox KA, Goodman SG, Anderson FA, Granger CB, Moscucci M, Flather MD, Spencer F, Budaj A, Dabbous OH, Gore JM: From guidelines to clinical practice: the impact of hospital and geographical characteristics on temporal trends in the management of acute coronary syndromes. The Global Registry of Acute Coronary Events (GRACE). Eur Heart J. 2003, 24: 1414-1424. 10.1016/S0195-668X(03)00315-4.CrossRefPubMed
17.
Budaj A, Flasinska K, Gore JM, Anderson FA, Dabbous OH, Spencer FA, Goldberg RJ, Fox KA: Magnitude of and risk factors for in-hospital and postdischarge stroke in patients with acute coronary syndromes: findings from a Global Registry of Acute Coronary Events. Circulation. 2005, 111: 3242-3247. 10.1161/CIRCULATIONAHA.104.512806.CrossRefPubMed
18.
Stenestrand U, Wallentin L: Årsrapport RIKS-HIA 2005. 2006
19.
de Winter RJ, Windhausen F, Cornel JH, Dunselman PH, Janus CL, Bendermacher PE, Michels HR, Sanders GT, Tijssen JG, Verheugt FW: Early invasive versus selectively invasive management for acute coronary syndromes. N Engl J Med. 2005, 353: 1095-1104. 10.1056/NEJMoa044259.CrossRefPubMed
20.
Zijlstra F, Hoorntje JC, de Boer MJ, Reiffers S, Miedema K, Ottervanger JP, van'T Hof AW, Suryapranata H: Long-term benefit of primary angioplasty as compared with thrombolytic therapy for acute myocardial infarction. N Engl J Med. 1999, 341: 1413-1419. 10.1056/NEJM199911043411901.CrossRefPubMed
21.
Andersen HR, Nielsen TT, Rasmussen K, Thuesen L, Kelbaek H, Thayssen P, Abildgaard U, Pedersen F, Madsen JK, Grande P, et al: A comparison of coronary angioplasty with fibrinolytic therapy in acute myocardial infarction. N Engl J Med. 2003, 349: 733-742. 10.1056/NEJMoa025142.CrossRefPubMed
22.
Terent A: Trends in stroke incidence and 10-year survival in Soderhamn, Sweden, 1975-2001. Stroke. 2003, 34: 1353-1358. 10.1161/01.STR.0000074038.71700.1C.CrossRefPubMed
23.
Kammersgaard LP, Jorgensen HS, Reith J, Nakayama H, Pedersen PM, Olsen TS: Short- and long-term prognosis for very old stroke patients. The Copenhagen Stroke Study. Age Ageing. 2004, 33: 149-154. 10.1093/ageing/afh052.CrossRefPubMed
24.
The National Stroke Register in Sweden: Analyserande rapport från Riks-Stroke. 2005
25.
Madsen MM, Busk M, Sondergaard HM, Bottcher M, Mortensen LS, Andersen HR, Nielsen TT: Does diabetes mellitus abolish the beneficial effect of primary coronary angioplasty on long-term risk of reinfarction after acute ST-segment elevation myocardial infarction compared with fibrinolysis? (A DANAMI-2 substudy). Am J Cardiol. 2005, 96: 1469-1475. 10.1016/j.amjcard.2005.07.053.CrossRefPubMed
26.
Dickstein K, Gleim GW, Snapinn S, James MK, Kjekshus J: The impact of morbid events on survival following hospitalization for complicated myocardial infarction. Eur J Heart Fail. 2006, 8: 74-80. 10.1016/j.ejheart.2005.04.010.CrossRefPubMed
27.
Wiseth R, Gundersen T, Halvorsen S, Nordrehaug JE, Steigen T, Myhre KI: PCI in acute myocardial infarction. SMM-rapport 2002(5). 2002
28.
Kløw N-E, Rotevatn S, Steigen T, Vatne K, Kristiansen IS: Wisløff T Norderhaug IN: Forebygging av restenose i hjertets kransårer. 2004
29.
Nordmann AJ, Briel M, Bucher HC: Mortality in randomized controlled trials comparing drug-eluting vs. bare metal stents in coronary artery disease: a meta-analysis. Eur Heart J. 2006, 27: 2784-2814. 10.1093/eurheartj/ehl282.CrossRefPubMed
30.
van Wijk I, Kappelle LJ, Van Gijn J, Koudstaal PJ, Franke CL, Vermeulen M, Gorter JW, Algra A: Long-term survival and vascular event risk after transient ischaemic attack or minor ischaemic stroke: a cohort study. Lancet. 2005, 365: 2098-2104. 10.1016/S0140-6736(05)66734-7.CrossRefPubMed
31.
32.
Loh E, Sutton MS, Wun CC, Rouleau JL, Flaker GC, Gottlieb SS, Lamas GA, Moye LA, Goldhaber SZ, Pfeffer MA: Ventricular dysfunction and the risk of stroke after myocardial infarction. N Engl J Med. 1997, 336: 251-257. 10.1056/NEJM199701233360403.CrossRefPubMed
33.
Dries DL, Rosenberg YD, Waclawiw MA, Domanski MJ: Ejection fraction and risk of thromboembolic events in patients with systolic dysfunction and sinus rhythm: evidence for gender differences in the studies of left ventricular dysfunction trials. J Am Coll Cardiol. 1997, 29: 1074-1080. 10.1016/S0735-1097(97)00019-3.CrossRefPubMed
34.
Mosterd A, Cost B, Hoes AW, de Bruijne MC, Deckers JW, Hofman A, Grobbee DE: The prognosis of heart failure in the general population: The Rotterdam Study. Eur Heart J. 2001, 22: 1318-1327. 10.1053/euhj.2000.2533.CrossRefPubMed
35.
Touze E, Varenne O, Chatellier G, Peyrard S, Rothwell PM, Mas JL: Risk of myocardial infarction and vascular death after transient ischemic attack and ischemic stroke: a systematic review and meta-analysis. Stroke. 2005, 36: 2748-2755. 10.1161/01.STR.0000190118.02275.33.CrossRefPubMed
36.
Hillen T, Coshall C, Tilling K, Rudd AG, McGovern R, Wolfe CD: Cause of stroke recurrence is multifactorial: patterns, risk factors, and outcomes of stroke recurrence in the South London Stroke Register. Stroke. 2003, 34: 1457-1463. 10.1161/01.STR.0000072985.24967.7F.CrossRefPubMed
37.
Caro JJ, Migliaccio-Walle K, Ishak KJ, Proskorovsky I, O'Brien JA: The time course of subsequent hospitalizations and associated costs in survivors of an ischemic stroke in Canada. BMC Health Serv Res. 2006, 6: 99-10.1186/1472-6963-6-99.CrossRefPubMedPubMedCentral
38.
Wright JT, Dunn JK, Cutler JA, Davis BR, Cushman WC, Ford CE, Haywood LJ, Leenen FH, Margolis KL, Papademetriou V, et al: Outcomes in hypertensive black and nonblack patients treated with chlorthalidone, amlodipine, and lisinopril. JAMA. 2005, 293: 1595-1608. 10.1001/jama.293.13.1595.CrossRefPubMed
39.
Gaziano TA, Opie LH, Weinstein MC: Cardiovascular disease prevention with a multidrug regimen in the developing world: a cost-effectiveness analysis. Lancet. 2006, 368: 679-686. 10.1016/S0140-6736(06)69252-0.CrossRefPubMedPubMedCentral
40.
Murray CJL, Lauer JA, Hutubessy RCW, Niessen L, Tomijima N, Rodgers A, Lawes CMM, Evans DB: Effectiveness and costs of interventions to lower systolic blood pressure and cholesterol: A global and regional analysis on reduction of cardiovascular-disease risk. Lancet. 2003, 361 (9359): 717-725. 10.1016/S0140-6736(03)12655-4. Date of Publication: 01 MAR 2003,CrossRefPubMed
41.
42.
Normaltariff for privat spesialistpraksis. 2008
43.
44.
45.
Briggs AH, Claxton K, Sculpher M: Decision Modelling for Health Economic Evaluation. 2006, Oxford University Press
46.
Critchfield GC, Willard KE: Probabilistic analysis of decision trees using Monte Carlo simulation. Med Decis Making. 1986, 6: 85-92. 10.1177/0272989X8600600205.CrossRefPubMed
47.
Sælensminde K: Helseeffekter i samfunnsøkonomiske analyser. 2007
48.
Claxton K, Paulden M, Gravelle H, Brouwer W, Culyer AJ: Discounting and decision making in the economic evaluation of health-care technologies. Health Econ. 2011, 20: 2-15. 10.1002/hec.1612.CrossRefPubMed
49.
Nord E: Discounting future health benefits: the poverty of consistency arguments. Health Econ. 2011, 20: 16-26. 10.1002/hec.1687.CrossRefPubMed
50.
Clinical Guideline 127: Hypertension - The clinical management of primary hypertension in adults. London, UK. 2011
51.
Lindholm LH, et al: Moderately elevated blood pressure. 2004
52.
Chen N, Zhou M, Yang M, Guo J, Zhu C, Yang J, Wang Y, Yang X, He L: Calcium channel blockers versus other classes of drugs for hypertension. Cochrane Database Syst Rev. 2010, CD003654-
53.
Drummond MF, Sculpher M, Torrance GW, O'Brien BJ, Stoddard GL: Methods for the economic evaluation of health care programmes;. 2005
54.
Kjeldsen SE, Jamerson KA, Bakris GL, Pitt B, Dahlof B, Velazquez EJ, Gupte J, Staikos L, Hua TA, Shi V, et al: Predictors of blood pressure response to intensified and fixed combination treatment of hypertension: the ACCOMPLISH study. Blood Press. 2008, 17: 7-17. 10.1080/08037050801972857.CrossRefPubMed
Metadata
Title
Choice of generic antihypertensive drugs for the primary prevention of cardiovascular disease - A cost-effectiveness analysis
Authors
Torbjørn Wisløff
Randi M Selmer
Sigrun Halvorsen
Atle Fretheim
Ole F Norheim
Ivar Sønbø Kristiansen
Publication date
01-12-2012
Publisher
BioMed Central
Published in
BMC Cardiovascular Disorders / Issue 1/2012
Electronic ISSN: 1471-2261
DOI
https://doi.org/10.1186/1471-2261-12-26

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