Abstract
The purpose of this study is to compare the cost-effectiveness of the 3 commercially available fixed-dose combinations (FDC) of angiotensin-II receptor blockers (ARBs) with hydrochlorothiazide (H). Published randomized controlled trials with FDC of losartan (L), telmisartan (T), and valsartan (V) with H were identified by MEDLINE search. Pooled estimates of systolic (sBP) and diastolic blood pressure (dBP) lowering and response rates were calculated using the meta-analytic technique of Cochran and DerSimonian with sample size and variance adjustments. Average reductions in sBP and dBP and average response rates were used to calculate cost-effectiveness ratios expressed as $ per mmHg reduction and $ per successfully treated patient. A total of 3883 patients were included in 14 trials with 1371 receiving L (8 cohorts), 1309 receiving T (2 cohorts), and 1203 receiving V (4 cohorts). Pooled estimates of sBP and dBP lowering and response rates and cost-effectiveness ratios are shown in the table. Drug/ Dose ΔsBP (mmHg) ΔdBP (mmHg) Response Rate (%) Annual AWP Cost ($) $ per mmHg ΔsBP $ per mmHg ΔdBP $ per % response rate V80 8.89 4.51 54 575 53 105 877 V160 10.19 5.30 59 511 50 96 866 V80/H12.5 14.59 7.71 64 511 35 66 798 V160/ H12.5 15.84 9.39 76 537 34 57 706 L50 8.5 4.65 41 474 56 102 1156 L100 8.83 4.72 44 712 81 151 1618 L50/H12.5 10.92 7.3 58 474 43 65 817 L100/H25 12.35 8.45 63 712 58 84 1130 T40 9.30 6.40 60 482 52 75 803 T80 12.50 7.10 66 482 39 68 730 T40/H12.5 17.40 11.70 81 482 28 41 595 T80/H12.5 18.80 12.30 85 482 26 39 567 Speakers' Bureau - Boehringer Ingelheim, Pfizer, Astra, Roche All doses of FDC of ARB plus H are more cost-effective than ARB alone, except L100/H25. L100/H25 is more cost-effective than L100, but not L50. T80/H12.5 is the most cost-effective ARB/H FDC.