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Economic evaluation of ASCOT-BPLA: antihypertensive treatment with an amlodipine-based regimen is cost effective compared with an atenolol-based regimen
  1. P Lindgren1,2,
  2. M Buxton3,
  3. T Kahan4,
  4. N R Poulter5,
  5. B Dahlöf6,
  6. P S Sever5,
  7. H Wedel7,
  8. B Jönsson8,
  9. on behalf of the ASCOT trial investigators*
  1. 1
    i3innovus, Stockholm, Sweden
  2. 2
    Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
  3. 3
    Brunel University, Uxbridge, UK
  4. 4
    Department of Clinical Science, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
  5. 5
    Imperial College, London, UK
  6. 6
    Sahlgrenska University Hospital/Östra, Göteborg, Sweden
  7. 7
    Nordic School of Public Health, Göteborg, Sweden
  8. 8
    Centre for Health Economics, Stockholm School of Economics, Stockholm, Sweden
  1. Dr P Lindgren, i3innovus, Vasagatan 38, 11120 Stockholm, Sweden; peter.lindgren{at}


Objective: To compare the cost effectiveness of an amlodipine-based strategy and an atenolol-based strategy in the treatment of hypertension in the UK and Sweden.

Design: A prospective, randomised 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 with bendroflumethiazide 1.25–2.5 mg and potassium added 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 with 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 with an atenolol-based regimen in the population studied.

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  • Competing interests: PL, MB, TK, NRP, BD, PSS, HW and BJ have served as consultants to, and received travel expenses, payment for speaking at meetings or funding for research from. pharmaceutical companies marketing antihypertensive drugs, including AstraZeneca, Sanofi-Aventis, Bayer, Bristol-Myers Squibb Co, Merck, Sharpe and Dohme, Novartis, Pfizer, Schering, and Servier. PL, MB, TK, NRP, BD, PSS, HW and BJ received financial support from Pfizer to cover administrative and staffing costs of ASCOT, and travel, accommodation expenses or both incurred by attending relevant meetings.

  • Funding: The study was supported by Pfizer, New York, USA.