Schwander Björn, Gradl Birgit, Zöllner York, Lindgren Peter, Diener Hans-Christoph, Lüders Stephan, Schrader Joachim, Villar Fernando Antoñanzas, Greiner Wolfgang, Jönsson Bengt
Analytica International, Lörrach, Germany.
Value Health. 2009 Sep;12(6):857-71. doi: 10.1111/j.1524-4733.2009.00507.x. Epub 2009 Mar 11.
To investigate the cost-utility of eprosartan versus enalapril (primary prevention) and versus nitrendipine (secondary prevention) on the basis of head-to-head evidence from randomized controlled trials.
The HEALTH model (Health Economic Assessment of Life with Teveten for Hypertension) is an object-oriented probabilistic Monte Carlo simulation model. It combines a Framingham-based risk calculation with a systolic blood pressure approach to estimate the relative risk reduction of cardiovascular and cerebrovascular events based on recent meta-analyses. In secondary prevention, an additional risk reduction is modeled for eprosartan according to the results of the MOSES study ("Morbidity and Mortality after Stroke--Eprosartan Compared to Nitrendipine for Secondary Prevention"). Costs and utilities were derived from published estimates considering European country-specific health-care payer perspectives.
Comparing eprosartan to enalapril in a primary prevention setting the mean costs per quality adjusted life year (QALY) gained were highest in Germany (Euro 24,036) followed by Belgium (Euro 17,863), the UK (Euro 16,364), Norway (Euro 13,834), Sweden (Euro 11,691) and Spain (Euro 7918). In a secondary prevention setting (eprosartan vs. nitrendipine) the highest costs per QALY gained have been observed in Germany (Euro 9136) followed by the UK (Euro 6008), Norway (Euro 1695), Sweden (Euro 907), Spain (Euro -2054) and Belgium (Euro -5767).
Considering a Euro 30,000 willingness-to-pay threshold per QALY gained, eprosartan is cost-effective as compared to enalapril in primary prevention (patients >or=50 years old and a systolic blood pressure >or=160 mm Hg) and cost-effective as compared to nitrendipine in secondary prevention (all investigated patients).
基于随机对照试验的直接比较证据，研究依普罗沙坦与依那普利（一级预防）以及与尼群地平（二级预防）相比的成本效用。
HEALTH模型（替米沙坦高血压健康经济评估模型）是一个面向对象的概率蒙特卡洛模拟模型。它将基于弗明汉姆的风险计算与收缩压方法相结合，以根据近期的荟萃分析估计心血管和脑血管事件的相对风险降低情况。在二级预防中，根据MOSES研究（“卒中后发病率和死亡率——依普罗沙坦与尼群地平二级预防比较”）的结果为依普罗沙坦模拟了额外的风险降低情况。成本和效用是从考虑欧洲各国医疗保健支付者视角的已发表估计中得出的。
在一级预防环境中比较依普罗沙坦与依那普利，每获得一个质量调整生命年（QALY）的平均成本在德国最高（24,036欧元），其次是比利时（17,863欧元）、英国（16,364欧元）、挪威（13,834欧元）、瑞典（11,691欧元）和西班牙（7918欧元）。在二级预防环境中（依普罗沙坦与尼群地平比较），每获得一个QALY的最高成本在德国观察到（9136欧元），其次是英国（6008欧元）、挪威（1695欧元）、瑞典（907欧元）、西班牙（-2054欧元）和比利时（-5767欧元）。
考虑到每获得一个QALY的支付意愿阈值为30,000欧元，在一级预防中（年龄≥50岁且收缩压≥160 mmHg的患者），依普罗沙坦与依那普利相比具有成本效益，在二级预防中（所有研究患者）与尼群地平相比具有成本效益。
