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.
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