The George Institute for Global Health, UNSW, Sydney, New South Wales, Australia
The George Institute for Global Health, UNSW, Sydney, New South Wales, Australia.
Heart. 2023 Oct 26;109(22):1698-1705. doi: 10.1136/heartjnl-2022-322300.
To determine the cost-effectiveness and cost-utility of a quadpill containing irbesartan 37.5 mg, amlodipine 1.25 mg, indapamide 0.625 mg and bisoprolol 2.5 mg in comparison with irbesartan 150 mg for people with hypertension who are either untreated or receiving monotherapy.
We conducted a within-trial and modelled economic evaluation of the Quadruple UltrA-low-dose tReaTment for hypErTension trial. The analysis was preplanned, and medications and health service use captured during the trial. The main outcomes were incremental cost-effectiveness ratios (ICERs) for cost per mm Hg systolic blood pressure (BP) reduction at 3 months, and modelled cost per quality-adjusted life year (QALY) over a lifetime.
The within-trial analysis showed no clear difference in cost per mm Hg BP lowering between randomised treatments at 3 months ($A10 (95% uncertainty interval (UI) $A -18 to $A37) per mm Hg per person) for quadpill versus monotherapy. The modelled cost-utility over a lifetime projected a mean incremental cost of $A265 (95% UI $A166 to $A357) and a mean 0.02 QALYs gained (95% UI 0.01 to 0.03) per person with quadpill therapy compared with monotherapy. Quadpill therapy was cost-effective in the base case (ICER of $A14 006 per QALY), and the result was sensitive to the quadpill cost in one-way sensitivity analysis.
Quadpill in comparison with monotherapy is comparably cost-effective for short-term BP lowering. In the long-term, quadpill therapy is likely to be cost-effective.
ANZCTRN12616001144404.
比较含有厄贝沙坦 37.5mg、氨氯地平 1.25mg、吲达帕胺 0.625mg 和比索洛尔 2.5mg 的四联 pill 与厄贝沙坦 150mg 治疗未经治疗或接受单药治疗的高血压患者的成本效益和成本效用。
我们对 Quadruple UltrA-low-dose tReaTment for hypErTension 试验进行了试验内和模型经济评估。该分析是预先计划的，并在试验期间捕获了药物和卫生服务的使用情况。主要结局是 3 个月时每降低 1mm Hg 收缩压（BP）的增量成本效果比（ICER），以及终生模型化的每质量调整生命年（QALY）的成本。
试验内分析显示，3 个月时随机治疗之间的每降低 1mm Hg BP 的成本差异不明显（四联 pill 组每人每降低 1mm Hg 血压的费用为$A10（95%不确定性区间（UI）$A -18 至$A37））与单药治疗相比。终生成本效用模型预测，四联 pill 治疗的平均增量成本为$A265（95% UI $A166 至$A357），与单药治疗相比，每人平均增加 0.02 个 QALY（95% UI 0.01 至 0.03）。四联 pill 治疗在基础情况下具有成本效益（ICER 为每 QALY$A14006），并且在单向敏感性分析中对四联 pill 成本敏感。
四联 pill 与单药治疗相比，在短期降低血压方面具有相当的成本效益。从长期来看，四联 pill 治疗可能具有成本效益。
ANZCTRN12616001144404。
