Cost-effectiveness analysis of antihypertensive triple combination therapy among patients enrolled in a Medicare advantage plan

ABSTRACT

Objective

To assess the cost-effectiveness of single pill fixed dose triple combination therapy vs. free triple combination therapy for the prevention of cardiovascular events among patients with hypertension.

Methods

A Markov model with a five year cycle was constructed. Two decision models incorporating strict and more relaxed adherence definitions estimated quality adjusted life years (QALYs) and health-care costs for single pill fixed triple combination therapy vs. free-drug combination therapy.

Results

When the strict adherence measurement criteria were applied, the total QALYs loss and cost/patient were 6.38 QALYs, $486,026.20 for the single pill triple combination therapy and 8.64 QALYs, $406,405.26 for the free combination therapy. ICER for single pill combination therapy compared to free combination therapy was 33,826.46/QALY. When the relaxed adherence measurement criteria were applied, the total QALYs loss and cost/patient were 8.09 QALYs, $493,404.26 for the single pill triple combination therapy and 8.76 QALYs, $436,415.14 for the free combination therapy. ICER for single pill combination compared with free combination therapy was 84,932.26.

Conclusion

This study suggested that single pill triple combination therapy was cost-effective in comparison with free combination therapy under a willingness to pay threshold of 50,000 when the strict adherence measurement criteria was applied.

KEYWORDS:

• Combination antihypertensive
• single pill
• free drug
• adherence
• cost-effectiveness

Author contributions

All authors agree to be accountable for all aspects of the work.

XW and SA were involved in the conception, design, analysis, interpretation of the data, drafting of the paper and revising it critically for intellectual content, and approval of the version to be published.

HC, EE, JW, OS, and RP were involved in the conception, design, interpretation of the data, drafting of the paper and revising it critically for intellectual content, and approval of the version to be published.

Declaration of interest

Xin Wang, Hua Chen, Essien EJ, Jun Wu, Omar Serna, Rutugandha Paranjpe, and Susan Abughosh declare that they have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewers disclosure

Peer reviewers on this manuscript have no relevant financial relationships or otherwise to disclose.

Additional information

Funding

There was no funding obtained for this study.