Van Bortel L M, Ament A J
Department of Pharmacology, University of Limburg, Maastricht, The Netherlands.
Pharmacoeconomics. 1995 Dec;8(6):513-23. doi: 10.2165/00019053-199508060-00006.
The application of cost-effectiveness methodology is particularly important in widespread diseases such as hypertension. However, because prospective cost-effectiveness analyses comparing different antihypertensive drugs are not currently available, differences in the cost effectiveness of these drugs can only be estimated. The purpose of this review is to estimate and compare the costs of drug therapy with selective and nonselective beta adrenoceptor antagonists in hypertension. The global costs of antihypertensive treatment are largely determined by drug costs. In most countries, drug costs do not appear to vary substantially between beta 1-selective and nonselective beta-blockers. The adverse sequelae of hypertension include stroke, myocardial infarction, cardiac hypertrophy and renal failure. There are no obvious differences in effect on stroke and cardiac hypertrophy between beta 1-selective and nonselective beta-blockers. However, compared with beta 1-selective antagonists, nonselective drugs might be less effective in preventing myocardial infarction in smokers and may impair renal function in patients with both increased peripheral resistance and declining cardiac output. There is a clear difference between beta 1-selective and nonselective beta-blockers on quality-of-life (QOL) perception. During treatment with nonselective beta-blockers, QOL perception is lower than during treatment with beta 1-selective drugs. Preservation of quality of life during long term antihypertensive treatment deserves considerable weight in economic analyses. Consequently, the more favourable effects of beta 1-selective agents on quality of life may outweigh the possible higher costs of these drugs, and suggest that beta 1-selective agents may be more cost effective than nonselective beta-blockers.
成本效益方法的应用在诸如高血压等广泛流行的疾病中尤为重要。然而，由于目前尚无比较不同抗高血压药物的前瞻性成本效益分析，这些药物在成本效益方面的差异只能进行估算。本综述的目的是估算并比较高血压患者使用选择性和非选择性β肾上腺素能受体拮抗剂进行药物治疗的成本。抗高血压治疗的总体成本在很大程度上由药物成本决定。在大多数国家，β1选择性和非选择性β受体阻滞剂之间的药物成本似乎没有显著差异。高血压的不良后果包括中风、心肌梗死、心脏肥大和肾衰竭。β1选择性和非选择性β受体阻滞剂对中风和心脏肥大的影响没有明显差异。然而，与β1选择性拮抗剂相比，非选择性药物在预防吸烟者心肌梗死方面可能效果较差，并且可能损害外周阻力增加且心输出量下降患者的肾功能。β1选择性和非选择性β受体阻滞剂在生活质量（QOL）认知方面存在明显差异。在使用非选择性β受体阻滞剂治疗期间，生活质量认知低于使用β1选择性药物治疗期间。在长期抗高血压治疗期间保持生活质量在经济分析中值得给予相当的权重。因此，β1选择性药物对生活质量的更有利影响可能超过这些药物可能更高的成本，并表明β1选择性药物可能比非选择性β受体阻滞剂更具成本效益。
