Cost-Effectiveness Analysis of Angiotensin-II Receptor Blocker in Hypertension Patients at Tertiary Hospital

Abstract

Background: During 2017 to 2019, angiotensin-II Receptor Blocker- treat patients accounted for 9.5 million baht in each year at this tertiary hospital. Essential drug was most frequently prescribed as health policy directed. Utilization cost of non-essential drug was doubled whereas essential drug usage was approximately fourfold to non-essential drug. Cost-effectiveness analysis will represent which drug is more worthiness to manage drug procurement. Objective: To evaluate the cost- effectiveness of achieving JNC8 with angiotensin-II receptor blockers compare between essential drug and non-essential drug. Method: Cost- effectiveness of azilsartan, candesartan, irbesartan, losartan, olmesartan and valsartan were obtained from medical claims database between January 1, 2017 and December 30, 2019. Patients with a diagnosis of hypertension in the 6- month baseline and ARB–free during baseline were included. The effectiveness was conducted in terms of number of patients who reached JNC8 BP goals within 24 weeks after the first date of ARB claim. The attributable costs were defined as the cost of ARB class and other classes that associated with hypertension treatment i.e. ACE inhibitors, beta-blockers, calcium channel blockers and diuretics. Cost- effectiveness analysis was compared to losartan. SPSS version 25.0 was used in this study. Result: 2198 patients were identified (mean age 57 ± 13 year, 38.0 % male, body mass index 27 ± 5). Comorbidity diseases were mostly for dyslipidemia (E78) 33.94% and diabetes (E119) 9.19%.Based on antihypertensive efficacy versus losartan within 24 weeks, low dose of candesartan and irbesartan reduced SBP significantly (p <.05) while olmesartan and valsartan reduced DBP significantly (p < .001). High dose of azilsartan and olmesartan reduced significant SBP and DBP respectively (p < .05, p < .001).The most benefit was valsartan of low dose and candesartan of high dose. This study was taken from real world data so the difference of heterogeneity such as type and number of co-morbidities diseases might cause of uncertainty and also the number of patients in each drug could not desirable. Conclusion: Overall valsartan was favored of the most cost- effectiveness for low dose and candesartan for high dose compared to losartan as of essential drug comparator.