RESUMEN
BACKGROUND: This retrospective study compared the efficacy, tolerability, and cost of two dihydropyridine calcium channel blockers. METHODS: Charts of patients who had been on continuous antihypertensive therapy with amlodipine or felodipine for at least 6 months were reviewed. Analyses include mean changes in blood pressure, percentage of patients achieving blood pressure (BP) < 140/90 mm Hg, average dose, and cost per day of the two calcium channel blockers, average cost of additional medication, total medication cost per day, and cost to achieve BP control. RESULTS: Eighty-seven percent of amlodipine-treated patients achieved BP control compared with 33% of felodipine-treated patients. Total medication cost to achieve BP control was 0.87 dollars per day for patients on amlodipine compared with 1.79 dollars per day for patients on felodipine. CONCLUSIONS: Amlodipine produced BP control in a greater percentage of patients than did felodipine at a lower total cost to achieve BP control. When evaluating the total cost of antihypertensive treatment, the cost of a drug alone can be misleading.
Asunto(s)
Amlodipino/uso terapéutico , Antihipertensivos/uso terapéutico , Bloqueadores de los Canales de Calcio/uso terapéutico , Felodipino/uso terapéutico , Hipertensión/tratamiento farmacológico , Personal Militar/estadística & datos numéricos , Medicina Naval/métodos , Amlodipino/economía , Amlodipino/farmacología , Análisis de Varianza , Antihipertensivos/economía , Antihipertensivos/farmacología , Presión Sanguínea/efectos de los fármacos , Bloqueadores de los Canales de Calcio/economía , Bloqueadores de los Canales de Calcio/farmacología , Control de Costos , Costos de los Medicamentos/estadística & datos numéricos , Felodipino/economía , Felodipino/farmacología , Femenino , Florida , Hospitales Militares , Humanos , Masculino , Auditoría Médica , Persona de Mediana Edad , Medicina Naval/economía , Estudios Retrospectivos , Estadísticas no Paramétricas , Resultado del TratamientoRESUMEN
OBJECTIVES: To investigate the marginal cost-effectiveness of different targets for the reduction of blood pressure and the cost-effectiveness of adding acetylsalicylic acid (ASA) to the treatment of hypertension. DESIGN: Patients with hypertension were randomized to three target groups for blood pressure; < or =90, < or =85 and < or =80 mmHg. Patients were also randomly assigned ASA and placebo. The average follow-up time was 3.8 years. The direct costs for drugs, visits, hospitalizations, and side-effects were calculated and related to clinical outcome. SETTING: Resource utilization data from all the 26 countries in the study were pooled, and Swedish unit costs were applied to the aggregated resource utilization. SUBJECTS: A total of 18 790 patients, 50-80 years of age (mean 61.5 years), with a diastolic blood pressure between 100 and 115 mmHg (mean 105 mmHg). INTERVENTIONS: Antihypertensive treatment with the long-acting calcium antagonist felodipine was given to all patients. Additional therapy and dose increments in four further steps were prescribed to reach the randomized target blood pressure. Fifty per cent of the patients were randomized to a low dose, 75 mg daily, of acetylsalicylic acid. MAIN OUTCOME MEASURES: Direct health care costs, major cardiovascular (CV) events (myocardial infarction and stroke) and CV death. RESULTS: The average cost of drugs and visits increased with more intensive treatment. The increase in treatment costs was partly but not fully offset by a nonsignificant reduction in the cost of CV hospitalizations. For patients with diabetes there were no significant differences in total cost between the target groups. The cost of avoiding a major CV event was negative in the base case analysis, SEK -10 360 (CI: -78 195, 75 630), and SEK 18 450 (CI: -88 789, 192 980) in a sensitivity analysis. For patients on ASA, costs were slightly but significantly higher than for patients on placebo. The estimates of the cost of avoiding a major CV event varied between SEK 41 600 and SEK 477 400, with very wide confidence intervals. CONCLUSIONS: The treatment cost increases as the target for hypertension treatment is lowered. In patients with diabetes, intensive treatment to a lower target is cost-effective. Because of the nonsignificant difference in events, no conclusion can be made for all patients in the study. Furthermore, no conclusive evidence was found regarding the cost-effectiveness of adding ASA to the treatment of hypertension.
Asunto(s)
Antihipertensivos/economía , Aspirina/economía , Bloqueadores de los Canales de Calcio/economía , Hipertensión/economía , Inhibidores de Agregación Plaquetaria/economía , Anciano , Aspirina/administración & dosificación , Presión Sanguínea/fisiología , Bloqueadores de los Canales de Calcio/uso terapéutico , Análisis Costo-Beneficio/métodos , Muerte Súbita Cardíaca , Angiopatías Diabéticas/tratamiento farmacológico , Angiopatías Diabéticas/economía , Quimioterapia Combinada , Felodipino/economía , Felodipino/uso terapéutico , Femenino , Costos de Hospital , Humanos , Hipertensión/tratamiento farmacológico , Hipertensión/prevención & control , Masculino , Persona de Mediana Edad , Infarto del Miocardio/economía , Infarto del Miocardio/prevención & control , Inhibidores de Agregación Plaquetaria/administración & dosificación , Accidente Cerebrovascular/economía , Accidente Cerebrovascular/prevención & control , Resultado del TratamientoRESUMEN
BACKGROUND: Recent hypertension trials have demonstrated the importance of achieving goal blood pressures to reduce the risk of target organ damage. In patients with moderate to severe hypertension, the use of high-dose monotherapy and/or combinations of drugs are necessary to achieve these goals. Fixed-dose combination products may be useful in these patients by reducing the number of daily doses required to control blood pressure. OBJECTIVE: The objective of the present study was to evaluate the efficacy and safety of a therapeutic interchange between high-dose calcium channel blocker therapy and a fixed-dose combination of amlodipine/ benazepril (Lotrel; Novartis Pharmaceuticals, USA) in patients with moderate to severe hypertension. METHODS: A total of 75 patients were switched from amlodipine (n = 25), felodipine (n = 25), and nifedipine-GITS (n = 25) to amlodipine/benazepril. Twenty-eight of the 75 patients (37%) were taking either a beta-blocker or a diuretic in addition to the high-dose calcium channel blocker prior to the switch. Blood pressure control, side effects and the cost of the therapeutic interchange were evaluated in the year following the therapeutic interchange. RESULTS: Sixty-six of the 75 (88%) patients were successfully switched with maintenance of blood pressure control and without the development of new dose-limiting side effects. Reasons for treatment failure after the therapeutic interchange included loss of blood pressure control in five patients and the development of new dose-limiting side effects in four patients. These side effects included cough in three patients and rash in one patient. After accounting for differences in drug acquisition cost and costs related to the switch (clinic and emergency room and laboratory tests), a cost savings of $16030 for all 75 patients was realised in the first year. The per patient-per year cost savings was $214. CONCLUSIONS: Our data indicate that a therapeutic interchange from selected high-dose calcium channel blockers to a fixed-dose combination of amlodipine/ benazepril can be successfully accomplished in the majority of patients.
Asunto(s)
Amlodipino/uso terapéutico , Antihipertensivos/uso terapéutico , Benzazepinas/uso terapéutico , Bloqueadores de los Canales de Calcio/uso terapéutico , Hipertensión/tratamiento farmacológico , Adulto , Anciano , Amlodipino/efectos adversos , Amlodipino/economía , Antihipertensivos/efectos adversos , Antihipertensivos/economía , Benzazepinas/efectos adversos , Benzazepinas/economía , Presión Sanguínea/efectos de los fármacos , Bloqueadores de los Canales de Calcio/efectos adversos , Bloqueadores de los Canales de Calcio/economía , Costos y Análisis de Costo , Relación Dosis-Respuesta a Droga , Quimioterapia Combinada , Felodipino/efectos adversos , Felodipino/economía , Felodipino/uso terapéutico , Femenino , Humanos , Hipertensión/economía , Masculino , Persona de Mediana Edad , Nifedipino/efectos adversos , Nifedipino/economía , Nifedipino/uso terapéutico , Resultado del TratamientoAsunto(s)
Amlodipino/economía , Bloqueadores de los Canales de Calcio/economía , Enfermedades Cardiovasculares/economía , Felodipino/economía , Amlodipino/uso terapéutico , Bloqueadores de los Canales de Calcio/uso terapéutico , Enfermedades Cardiovasculares/tratamiento farmacológico , Felodipino/efectos adversos , Humanos , Resultado del TratamientoRESUMEN
We present results from a Swedish retrospective cost-effectiveness analysis of felodipine-metoprolol (Logimax) and enalapril in hypertension. In the 8-week trial, the average reduction of diastolic blood pressure (DBP) and the share of patients reaching target DBP were both significantly greater in the felodipine-metoprolol group. Cost of treatment (costs of drugs and physician visits) was somewhat higher in the felodipine-metoprolol group. After 8 weeks, an extra 4.8 mmHg reduction and an additional 22% of patients reaching target DBP were achieved with felodipine-metoprolol at the extra cost of SEK 19 (Swedish kronor, $US I=SEK 7.90). The incremental cost per mmHg reduction and per patient reaching target DBP was calculated at SEK 4 and SEK 86, respectively. Average cost-effectiveness ratios showed that the costs per mmHg reduction and per patient reaching target DBP after 8 weeks were 40 and 34% lower in the felodipine-metoprolol group, respectively. In conclusion, felodipine-metoprolol is cost-effective in the treatment of hypertension.
Asunto(s)
Antihipertensivos/uso terapéutico , Enalapril/uso terapéutico , Felodipino/uso terapéutico , Hipertensión/tratamiento farmacológico , Metoprolol/uso terapéutico , Adulto , Anciano , Antihipertensivos/economía , Análisis Costo-Beneficio , Combinación de Medicamentos , Enalapril/economía , Felodipino/economía , Femenino , Humanos , Hipertensión/economía , Masculino , Metoprolol/economía , Persona de Mediana Edad , Estudios Retrospectivos , SueciaRESUMEN
We studied the therapeutic substitution of a less expensive but equally effective antihypertensive agent and assessed patient outcome. The medication of 39 patients with hypertension was changed from once-daily diltiazem hydrochloride (Cardizem CD) or nifedipine (Procardia XL) to felodipine (Plendil). Titration to a final dose was based on home and office blood pressure measurements assessed over subsequent follow-up clinic visits. Self-administered questionnaires measured different aspects of well-being and symptoms before and after the change in medication. Eighty percent of the cohort switched successfully to felodipine. Office systolic and diastolic pressures improved after the medication change (systolic: 150 mm Hg versus 144 mm Hg; diastolic: 92 mm Hg versus 87 mm Hg). No statistically significant differences were found among the 39 symptoms measured. A yearly savings potential for our institution was estimated to be $72,000.