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Economic Evaluation of ASCOT-BPLA: Antihypertensive treatment with an amlodipine-based regimen is cost-effective compared to an atenolol-based regimen


Objective To assess the cost-effectiveness of an amlodipine-based strategy compared to an atenolol-based strategy in the treatment of hypertension in the UK and Sweden.

Design A prospective, randomized trial complemented with a Markov model to assess long-term costs and health effects.

Setting Primary care.

Patients Patients with moderate hypertension and three or more additional risk factors.

Interventions Amlodipine 5-10 mg with perindopril 4-8 mg added as needed or atenolol 50-100 mg adding bendroflumethiazide 1.25–2.5 mg and potassium as needed

Main outcome measures Cost per cardiovascular event and procedure avoided, and cost per quality-adjusted life year gained.

Results In the UK, the cost to avoid one cardiovascular event or procedure would be 18 965 €, and the cost to gain one quality-adjusted life year would be 21 875 €. The corresponding figures for Sweden were 13 210 € and 16 856 €.

Conclusions Compared to the thresholds applied by NICE and in the Swedish National Board of Health and Welfare's Guidelines for Cardiac Care, an amlodipine-based regimen is cost-effective for the treatment of hypertension, compared to an atenolol-based regimen in the population studied.

  • amlodipine
  • atenolol
  • cost-effectiveness
  • hypertension
  • primary prevention

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