Jönsson Bengt, Carides George W, Burke Thomas A, Dasbach Erik J, Lindholm Lars H, Dahlöf Björn
Stockholm School of Economics, Stockholm, Sweden.
J Hypertens. 2005 Jul;23(7):1425-31. doi: 10.1097/01.hjh.0000173527.73179.f5.
Evaluate the cost effectiveness of losartan compared with atenolol from a Swedish national health system perspective.
The Losartan Intervention For Endpoint reduction in hypertension study (LIFE) was a double-masked, randomized trial of losartan versus atenolol in 9193 patients with essential hypertension and left ventricular hypertrophy (LVH) ascertained by electrocardiography. Losartan reduced the primary composite end point of cardiovascular death, myocardial infarction (MI), or stroke by 13% (P = 0.021) and reduced the risk of stroke by 25% (P = 0.001), despite a comparable degree of blood pressure control.
Life years gained was estimated by combining the absolute risk reduction in stroke with the life years gained by preventing stroke. Quality-adjusted life years (QALYs) gained was estimated by combining the absolute risk reduction in stroke with the QALYs gained by preventing stroke. QALYs were estimated by weighting life years by health-related quality of life (QoL), as measured with visual analogue scale (VAS) data collected in the trial. Net costs were defined as the total of study medication cost, stroke-related costs, and costs of increased survival. Costs are in 2003 Swedish prices. All costs and effects were discounted at a 3% annual rate.
Prevention of a stroke resulted in a gain of 5.7 life years and 4.3 QALYs. As a consequence, losartan treatment resulted in a per patient increase of 0.092 life years [95% confidence interval (CI): 0.038, 0.146] and 0.069 QALYs (95% CI: 0.028, 0.109) as compared with atenolol treatment. Losartan reduced direct stroke-related cost per patient by 1141 euros due to a lower cumulative incidence of stroke for losartan at 5.5 years (4.9%) as compared with atenolol (6.5%) (95% CI of difference: 0.7, 2.5). The reduction in stroke-related cost offset 80% of the added cost of losartan drug therapy. After inclusion of study medication cost, net cost per patient was 289 euros higher for losartan than atenolol. The net cost per QALY gained for losartan was 4188 euros (37,813 SEK), which is well within common Swedish benchmark upper values (200-500,000 SEK) for accepted cost-effective interventions.
Based on the results from the LIFE trial, treatment with losartan compared with atenolol, in hypertensive patients with LVH, is a cost-effective intervention.
从瑞典国家卫生系统的角度评估氯沙坦与阿替洛尔相比的成本效益。
氯沙坦干预降低高血压终点研究（LIFE）是一项双盲、随机试验，在9193例原发性高血压且经心电图确诊为左心室肥厚（LVH）的患者中比较氯沙坦与阿替洛尔。尽管血压控制程度相当，但氯沙坦使心血管死亡、心肌梗死（MI）或中风的主要复合终点降低了13%（P = 0.021），使中风风险降低了25%（P = 0.001）。
通过将中风绝对风险降低与预防中风所获得的生命年相结合来估计获得的生命年。通过将中风绝对风险降低与预防中风所获得的质量调整生命年（QALY）相结合来估计获得的QALY。QALY通过用试验中收集的视觉模拟量表（VAS）数据测量的与健康相关的生活质量（QoL）对生命年进行加权来估计。净成本定义为研究药物成本、中风相关成本和生存增加成本的总和。成本以2003年瑞典价格计算。所有成本和效果均按每年3%的贴现率进行贴现。
预防一次中风可使生命年增加5.7年，QALY增加4.3个。因此，与阿替洛尔治疗相比，氯沙坦治疗使每位患者的生命年增加0.092年[95%置信区间（CI）：0.038，0.146]，QALY增加0.069个（95%CI：0.028，0.109）。由于氯沙坦在5.5年时中风的累积发生率较低（4.9%），而阿替洛尔为（6.5%），氯沙坦使每位患者与中风直接相关的成本降低了1141欧元（差异的95%CI：0.7，2.5）。中风相关成本的降低抵消了氯沙坦药物治疗额外成本的80%。纳入研究药物成本后，氯沙坦每位患者的净成本比阿替洛尔高289欧元。氯沙坦每获得一个QALY的净成本为4188欧元（37,813瑞典克朗），这完全在瑞典常见的可接受成本效益干预基准上限值（200 - 500,000瑞典克朗）范围内。
基于LIFE试验的结果，在患有LVH的高血压患者中，与阿替洛尔相比，氯沙坦治疗是一种具有成本效益的干预措施。
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