Cost-utility of angiotensin-converting enzyme inhibitor compared to thiazide diuretic-based treatment for hypertension in elderly Australians considering diabetes as comorbidity
OBJECTIVE: To examine the cost-effectiveness of angiotensin-converting enzyme inhibitor-based (ACEI) treatment compared to thiazide diuretic-based treatment for hypertension in elderly Australians considering diabetes as an outcome along with cardiovascular outcomes from the Australian government pe...
| Main Authors: | , , , , |
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| Format: | Journal Article |
| Published: |
2015
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| Online Access: | http://hdl.handle.net/20.500.11937/44824 |
| _version_ | 1848757112204689408 |
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| author | Chowdhury, E. Ademi, Z. Moss, J. Wing, L. Reid, Christopher |
| author_facet | Chowdhury, E. Ademi, Z. Moss, J. Wing, L. Reid, Christopher |
| author_sort | Chowdhury, E. |
| building | Curtin Institutional Repository |
| collection | Online Access |
| description | OBJECTIVE: To examine the cost-effectiveness of angiotensin-converting enzyme inhibitor-based (ACEI) treatment compared to thiazide diuretic-based treatment for hypertension in elderly Australians considering diabetes as an outcome along with cardiovascular outcomes from the Australian government perspective. DESIGN AND METHOD: We used a cost-utility analysis to estimate the incremental cost-effectiveness ratio (ICER) per quality-adjusted life-year (QALY) gained. Data on cardiovascular events and new-onset of diabetes were used from the Second Australian National Blood Pressure Study, a randomized clinical trial comparing diuretic-based (hydrochlorothiazide) versus ACEI-based (enalapril) treatment in 6083 elderly (age 65yrs or more) hypertensive patients over a median 4.1-year period. For this economic analysis, the total study population was stratified into two groups. Group A was restricted to participants diabetes-free at baseline (n?=?5,642); and Group B was restricted to participants with pre-existing diabetes mellitus (Type I or Type II) at baseline (n?=?441). Data on utility scores for different events were used from available published literatures; whereas, treatment and adverse event management cost were calculated from direct health care costs available from Australian Government reimbursement data. Quality of life and costs were discounted at 5% per annum. One-way and probabilistic sensitivity analyses were performed to assess the uncertainty around utilities and cost data. RESULTS: After a treatment period of five years, for Group A the ICER was AUD 27,698 (Euro 18,004; AUD 1~ &OV0556; 0.65) per QALY gained comparing ACEI-based with diuretic-based treatment (sensitive to the utility value for new-onset diabetes). In Group B, ACEI-based treatment was a dominant strategy (both more effective and cost-saving). On probabilistic sensitivity analysis, the ICERs per QALY gained were always below AUD 50,000 for Group B; whereas for Group A the probability of being below AUD 50,000 was 85%. CONCLUSIONS: Although the dispensed price of diuretic-based treatment of hypertension in the elderly is lower, upon considering the potential enhanced likelihood of the development of diabetes in addition to the costs of treating cardiovascular disease, ACEI-based treatment may be a more cost-effective strategy in this population. |
| first_indexed | 2025-11-14T09:22:55Z |
| format | Journal Article |
| id | curtin-20.500.11937-44824 |
| institution | Curtin University Malaysia |
| institution_category | Local University |
| last_indexed | 2025-11-14T09:22:55Z |
| publishDate | 2015 |
| recordtype | eprints |
| repository_type | Digital Repository |
| spelling | curtin-20.500.11937-448242018-12-14T00:56:19Z Cost-utility of angiotensin-converting enzyme inhibitor compared to thiazide diuretic-based treatment for hypertension in elderly Australians considering diabetes as comorbidity Chowdhury, E. Ademi, Z. Moss, J. Wing, L. Reid, Christopher OBJECTIVE: To examine the cost-effectiveness of angiotensin-converting enzyme inhibitor-based (ACEI) treatment compared to thiazide diuretic-based treatment for hypertension in elderly Australians considering diabetes as an outcome along with cardiovascular outcomes from the Australian government perspective. DESIGN AND METHOD: We used a cost-utility analysis to estimate the incremental cost-effectiveness ratio (ICER) per quality-adjusted life-year (QALY) gained. Data on cardiovascular events and new-onset of diabetes were used from the Second Australian National Blood Pressure Study, a randomized clinical trial comparing diuretic-based (hydrochlorothiazide) versus ACEI-based (enalapril) treatment in 6083 elderly (age 65yrs or more) hypertensive patients over a median 4.1-year period. For this economic analysis, the total study population was stratified into two groups. Group A was restricted to participants diabetes-free at baseline (n?=?5,642); and Group B was restricted to participants with pre-existing diabetes mellitus (Type I or Type II) at baseline (n?=?441). Data on utility scores for different events were used from available published literatures; whereas, treatment and adverse event management cost were calculated from direct health care costs available from Australian Government reimbursement data. Quality of life and costs were discounted at 5% per annum. One-way and probabilistic sensitivity analyses were performed to assess the uncertainty around utilities and cost data. RESULTS: After a treatment period of five years, for Group A the ICER was AUD 27,698 (Euro 18,004; AUD 1~ &OV0556; 0.65) per QALY gained comparing ACEI-based with diuretic-based treatment (sensitive to the utility value for new-onset diabetes). In Group B, ACEI-based treatment was a dominant strategy (both more effective and cost-saving). On probabilistic sensitivity analysis, the ICERs per QALY gained were always below AUD 50,000 for Group B; whereas for Group A the probability of being below AUD 50,000 was 85%. CONCLUSIONS: Although the dispensed price of diuretic-based treatment of hypertension in the elderly is lower, upon considering the potential enhanced likelihood of the development of diabetes in addition to the costs of treating cardiovascular disease, ACEI-based treatment may be a more cost-effective strategy in this population. 2015 Journal Article http://hdl.handle.net/20.500.11937/44824 10.1097/01.hjh.0000467488.12815.b6 restricted |
| spellingShingle | Chowdhury, E. Ademi, Z. Moss, J. Wing, L. Reid, Christopher Cost-utility of angiotensin-converting enzyme inhibitor compared to thiazide diuretic-based treatment for hypertension in elderly Australians considering diabetes as comorbidity |
| title | Cost-utility of angiotensin-converting enzyme inhibitor compared to thiazide diuretic-based treatment for hypertension in elderly Australians considering diabetes as comorbidity |
| title_full | Cost-utility of angiotensin-converting enzyme inhibitor compared to thiazide diuretic-based treatment for hypertension in elderly Australians considering diabetes as comorbidity |
| title_fullStr | Cost-utility of angiotensin-converting enzyme inhibitor compared to thiazide diuretic-based treatment for hypertension in elderly Australians considering diabetes as comorbidity |
| title_full_unstemmed | Cost-utility of angiotensin-converting enzyme inhibitor compared to thiazide diuretic-based treatment for hypertension in elderly Australians considering diabetes as comorbidity |
| title_short | Cost-utility of angiotensin-converting enzyme inhibitor compared to thiazide diuretic-based treatment for hypertension in elderly Australians considering diabetes as comorbidity |
| title_sort | cost-utility of angiotensin-converting enzyme inhibitor compared to thiazide diuretic-based treatment for hypertension in elderly australians considering diabetes as comorbidity |
| url | http://hdl.handle.net/20.500.11937/44824 |