Objective To evaluate the cost-effectiveness of low-dose amlodipine plus telmisartan (group A) or amlodipine plus amiroride (group B) therapy in hypertensive patients using a decision-tree model with a time horizon of 1 year. To provide evidence on the optimal combination therapy regimens and treatment options in hypertensive patients.
Method Based on the trial data, a cost-effectiveness decision-tree model was developed to assess, about 1 year period, the short-time economic effects, where the total effective rates, Blood pressure control rates and QALYs were estimated as indicators of effectiveness, respectively. Roll back, cost-effectiveness analysis, cost-utility analysis and incremental cost-effectiveness analysis wore adopted in the decision-tree model. Both one-way and two-way sensitivity analysis were carried out to determine the robustness of our baseline results.
Results 1. Expected values: About the average cost per patient needed with a time horizon of 1 year, group A need ¥1247, group B need ¥1917. About the total effective rates and blood pressure control rates, group A reached 87.6% and 80.9%, group B reached 84.0% and 70.7%. About the average QALYs per patient gained, group A were 0.046 QALYs and group B were 0.085 QALYs. 2. The one year cost-effectiveness analysis showed that, the cost of effective treatment was ¥1389 and ¥2230 per patient in group A and group B, respectively.At the cost of blood pressure controlled for each case, group A need ¥1540, and group B require ¥2712. At the cost of gain 1 QALY after 1 year therapy, group A need ¥26979, and group B require ¥22517. The estimated ICER for group A vs group B was ¥17222 per QALY gained. 3. The sensitivity analysis results showed that there were no impact of variations in key model inputs on the model.
Conclusion From group decision-making considerations, applying the economic benefit, the initial low-dose amlodipine plus amiloride is optimal opinion; And consider from improving the quality of life, amlodipine plus telmisartan is prefered scheme.
- combination therapy
- decision-tree model
- cost-effectiveness analysis
- cost-utility analysis
- incremental analysis
- pharmacoeconomics evaluation