Abstract
OBJECTIVE
Cost-effectiveness analysis of combined enalapril-nitrendipine therapy (E/N), as second-line therapy for light or moderate hypertension.
DESIGN
Theoretical model of cost-effectiveness, based on the norms of hypertension treatment in primary care, the considered view of a panel of experts and the direct costs of health resources and purchase of medication.
SETTING
Spanish National Health system.
PARTICIPANTS
Simulation of 1000 patients with hypertension, with a time horizon of one year.
INTERVENTIONS
After a prior failure of the first-line treatment with either enalapril or nitrendipine, an evaluation was made of the possibilities of increasing dosage of the first-line treatment, changing the drug or administering the E/N combination.
MAIN MEASUREMENT
The likelihoods, in the primary care context, of controlling diastolic pressure, of abandonment and of using the two strategies or not were measured, as were the use of health resources in each situation, and costs of resource use and of medication.
RESULTS
The cost-effectiveness quotient of the combined E/N treatment was consistently more efficient than the increase in dose or change to another drug. This was so, whether the treatment was started with enalapril (301.06 euros vs 337.97 euros and 588.42 euros) or with nitrendipine (331.5 euros vs 469.88 euros and 579.76 euros).
CONCLUSIONS
Combined therapy (E/N) is, on the basis of the assumptions made in the model, an efficient therapy option. Therefore, it can be recommended for prescription.
Collapse