Columbia University, New York, NY, USA.
University of Utah, Salt Lake City, UT, USA.
J Hum Hypertens. 2023 Nov;37(11):985-992. doi: 10.1038/s41371-023-00811-3. Epub 2023 Feb 15.
Hypertension guidelines recommend initiating treatment with single pill combination (SPC) antihypertensive medications, but SPCs are used by only one-third of treated hypertensive US adults. This analysis estimated the cost-effectiveness of initial treatment with SPC dual antihypertensive medications compared with usual care monotherapy in hypertensive US adults.The validated BP Control Model-Cardiovascular Disease (CVD) Policy Model simulated initial SPC dual therapy (two half-standard doses in a single pill) compared with initial usual care monotherapy (half-standard dose when baseline systolic BP < 20 mmHg above goal and one standard dose when ≥20 mmHg above goal). Secondary analyses examined equivalent dose monotherapy (one standard dose) and equivalent dose dual therapy as separate pills (two half-standard doses). The primary outcomes were direct healthcare costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio (ICER) over 10 years from a US healthcare sector perspective.At 10 years, initial dual drug SPC was projected to yield 0.028 (95%UI 0.008 to 0.051) more QALYs at no greater cost ($73, 95%UI -$1 983 to $1 629) than usual care monotherapy. In secondary analysis, SPC dual therapy was cost-effective vs. equivalent dose monotherapy (ICER $8 000/QALY gained) and equivalent dose dual therapy as separate pills (ICER $57 000/QALY gained). At average drug prices, initiating antihypertensive treatment with SPC dual therapy is more effective at no greater cost than usual care initial monotherapy and has the potential to improve BP control rates and reduce the burden of CVD in the US.
高血压指南建议使用单片复方制剂（SPC）降压药物进行起始治疗，但接受治疗的美国高血压成人中只有三分之一使用 SPC。本分析评估了与常规护理单药治疗相比，起始使用 SPC 双联降压药物治疗美国高血压成人的成本效益。经验证的血压控制模型-心血管疾病（CVD）政策模型模拟了起始 SPC 双联治疗（单片中两种半标准剂量）与起始常规护理单药治疗（当基线收缩压高于目标 20mmHg 以上时使用半标准剂量，当高于目标 20mmHg 以上时使用标准剂量）。二次分析检查了等效剂量单药治疗（一种标准剂量）和作为单独片剂的等效剂量双联治疗（两种半标准剂量）。主要结局指标为从美国医疗保健部门角度评估的 10 年内的直接医疗保健成本、质量调整生命年（QALY）和增量成本效益比（ICER）。10 年内，与常规护理单药治疗相比，初始双联药物 SPC 预计可使 QALY 增加 0.028（95%UI 0.008 至 0.051），且成本无增加（73 美元，95%UI -1983 美元至 1629 美元）。在二次分析中，SPC 双联治疗与等效剂量单药治疗（ICER 8000 美元/QALY 获益）和等效剂量作为单独片剂的双联治疗（ICER 57000 美元/QALY 获益）相比具有成本效益。在平均药物价格下，与常规护理单药治疗相比，使用 SPC 双联治疗起始降压治疗更有效且成本相当，有可能提高血压控制率并降低美国 CVD 的负担。
