Cost-effectiveness analysis comparing single-pill combination of perindopril/amlodipine/indapamide to the free equivalent combination in patients with hypertension from an Italian national health system perspective

ABSTRACT

Objective

To evaluate the cost-effectiveness of a single-pill combination (SPC) of perindopril/amlodipine/indapamide versus its free equivalent combination (FEC) in adults with hypertension in Italy.

Methods

A Markov model was developed to perform a cost-utility analysis with a lifetime horizon and an Italian healthcare payer’s perspective. In the model, the additional effect of the SPC on blood pressure level compared with the FEC was translated into a decreased risk of cardiovascular events and CKD, which was modeled via Framingham risk algorithms. Difference in persistence rates of SPC and FEC were modeled via discontinuation rates.

Results

A perindopril/amlodipine/indapamide SPC is associated with lower cost and better health outcomes compared to its FEC. Over a lifetime horizon, it is associated with a 0.050 QALY gain and cost savings of €376, resulting from lower cardiovascular event rates. In the alternative scenario, where different approach for modeling impact of adherence was considered, incremental gain of 0.069 QALY and savings of €1,004 were observed. Results were robust to sensitivity and scenario analyses, indicating that use of this SPC is a cost-effective strategy.

Conclusions

The findings indicate that a perindopril/amlodipine/indapamide SPC is a cost-saving treatment option for hypertension in Italy, compared to its FEC.

KEYWORDS:

• Hypertension
• single-pill combination
• fixed-dose
• adherence
• persistence
• cost-effectiveness

Declaration of interests

P Levy has received an honorarium for critical input into the study design and data interpretation. T Lemański and C Crossan are employees of Putnam. Putnam received consulting fees from Servier to support the preparation of the analysis. J-B Briere and A Lefebvre were employees of Servier International at the time of the study. ZM. Khan was a paid consultant for Servier International at the time of the study. L Degli Esposti is an employee of CliCon s.r.l. Società Benefit. The agreement signed by Clicon S.r.l. Società Benefit and Servier International does not create any entity, joint venture or any similar relationship between parties. Clicon S.r.l. Società Benefit is an independent company. Neither CliCon S.r. l. Società Benefit nor any of their representatives are employees of Servier International for any purpose. The authors have no other 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 apart from those disclosed.

Reviewer Disclosures

A reviewer of this manuscript has disclosed they are an employee of The George Institute for Global Health. George Health Enterprises Pty Ltd, the social enterprise arm of The George Institute for Global Health (TGI), has received investment to develop fixed-dose combination products containing aspirin, statin and blood-pressure lowering drugs. TGI holds and have filed applications for methods of treatment and composition patents in relation to low and ultra-low-dose fixed-dose combination products for the treatment of hypertension and diabetes. All staff employed by TGI have an institutional interest to declare with respect to George Health Enterprises. None of the TGI staff have a financial interest in these investments. Peer reviewers in this manuscript have no other relevant financial relationships or otherwise to disclose.

Author contributions

P Levy: Conceptual input, review of the model assumptions, critical review and final approval of the manuscript. T Lemanski: Conception and development of the model, drafting the manuscript. C Crossan: Critical review and assistance in the development of the manuscript. A Lefebvre: Conceptual input, Critical review and final approval of the manuscript. J-B Briere: Conceptual input, Critical review of the manuscript. LD Esposti: Gathering country-specific data, Critical review and final approval of the manuscript. ZM. Khan: Conceptual input, assistance in the development of the model, critical review of the manuscript.

Acknowledgments

We thank Michał Pochopień for his meaningful conceptual input in developing the model. We also thank Karl Read for his copyedit review.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/14737167.2024.2365988.

Additional information

Funding

The present study and paper were funded by Servier.