Economic evaluation of four angiotensin II receptor blockers in the treatment of hypertension

Abstract

Objective:

To evaluate the cost effectiveness of achieving JNC 7 blood pressure goals with angiotensin II receptor blockers (ARBs).

Research design and methods:

Cost effectiveness of olmesartan, losartan, valsartan, and irbesartan was compared with real world patient chart and claims data from a large US health plan. Patients 18 and older with ≥2 claims for an ARB between May 1, 2002 and December 31, 2005 were identified from the claims database. Patients with a diagnosis of hypertension in the 6-month baseline period before the first (index) ARB claim and ARB-free during baseline were included. Medical charts were randomly sampled from the cohort of identified patients; effectiveness data were obtained from charts and linked to healthcare claims and costs. These data were used to populate the decision analytic model.

Main outcome measures:

All-cause and hypertension-attributable costs to achieve JNC 7 goals were measured. Comparisons were made within low and high-dose strata and pooled across ARB doses.

Results:

121 472 patients were identified, and charts were randomly abstracted for 1600. Of these, 1293 patients were hypertensive at index. Baseline patient characteristics for the chart group were modestly different from the larger cohort. More patients treated with olmesartan (77.8%) than with losartan (66.5%), valasartan (68.8%), or irbesartan (68.8%) achieved JNC 7 BP goals. In pooled-dose comparisons, cost per patient reaching BP goal was $8964 (all-cause) and $2704 (hypertension-attributable) for olmesartan; compared with $10 848 and $3291 for losartan; $10 557 and $3577 for valsartan; and $13395 and $4325 for irbesartan, respectively. The trend was similar for the dose stratification analysis, except in the comparison between high-dose losartan and olmesartan, where losartan had a lower cost-effectiveness ratio.

Conclusion:

Overall olmesartan was the most effective and cost-saving treatment option compared to losartan, valsartan, and irbesartan for the achievement of JNC 7 BP goals in this managed-care population.

Key words::

• Angiotensin II receptor blockers
• Cost effectiveness
• Irbesartan
• Losartan
• Olmesartan
• Valsartan

Transparency

Declaration of funding

Funding for this study was provided by Daiichi Sankyo, Inc. Parsippany, NJ, USA.

Declaration of financial/other relationships

S.P. and K.R. have disclosed that they are employees of, and hold stock in, DSI. D.D. has disclosed that he was an employee of HealthCore, Inc. during the course of the study, but is currently employed by The Children's Hospital of Philadelphia, Philadelphia, PA, USA. R.W. has disclosed that he was an employee of HealthCore, Inc. during the course of the study, but is currently employed by Cerner, Kansas City, MO, USA. L.M. has disclosed that she was at the University of Texas, M.D. Anderson Cancer Center, Drug Use Policy and Pharmacoeconomics, Houston, TX, USA during the course of the study, but is currently employed by Eli Lilly and Company, Indianapolis, IN, USA.

Some peer reviewers receive honoraria from CMRO for their review work. The peer reviewers of this paper have disclosed that they have no relevant financial relationships.

Acknowledgments

The authors thank Kevin Mayo, PhD and Michael Hagan, PhD. for their ideas and scientific support.

Portions of the manuscript have been presented in the form of an abstract and poster, as follows: Journal of Managed Care Pharmacy 2009;15:211 and Value in Health 2009;12:211.