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Table 1 Summary of the studies, medicines compared and conclusions

From: Economic evaluation for first-line anti-hypertensive medicines: applications for the Philippines

Title (author, year) Intervention and comparator Study population Setting and country Type of economic study Conclusions
Cost-effectiveness of antihypertensive treatment in Malaysia (Alefan et al., [19]) Diuretics, ACE inhibitors, prazosin, BB, diuretic and BB combination, CCB, and other combinations 670 hypertensive patients without comorbidities divided into controlled and uncontrolled groups A polyclinic in Malaysia Cost-effectiveness analysis Diuretics were the most cost-effective antihypertensive drugs followed by ACEIs, prazosin, BB, combination of diuretics and BB, CCBs and “other combinations”.
AT1 Receptor Blockers – Cost-effectiveness within the South African Context (Anderson et al. [20]) Candesartan, losartan, valsartan and irbesartan (all ARB) Values taken from existing internationally published data South Africa, but all studies derived from existing international published data Literature review and cost-effectiveness study Favoured candesartan as the most cost effective regimen among other ARBs
Thiazide diuretics as first-line treatment for hypertension: Meta-analysis and economic evaluation (Tran et al. [16]) Thiazides, CCB, BB, ACEI or ARB and no therapy For the base case analysis, the cohorts included men and women, 55–65 years old, with baseline SBP of 150 mmHg or 180 mmHg, all were non smokers with no diabetes or LVH, with normal cholesterol and HDL levels Data came from studies in the US, Sweden, Spain, UK, Canada, Greece, Italy and New Zealand; cost-utility analysis represented patients from Canada. Systematic literature review and cost-utility analysis Favoured thiazides as the most cost-effective option
Cost-minimization analysis of diuretic based antihypertensive therapy reducing cardiovascular events in older adults with isolated systolic hypertension (Chen et al., [21]) SHEP-based therapy (diuretic based plus reserpine or atenolol), BB, ACEI, alpha blocker, and CCB Men and women, 60 years or more, isolated systolic hypertension, classified into four risk groups: low, medium, high and very high; patients randomized to 2365 treatment group and 2371 placebo group USA Cost-minimization analysis Favoured diuretic based therapy even in patients at high risk for developing cardiovascular disease
Hypertension: Management in adults in primary care (NICE [22]) Thiazide diuretics, CCB, BB, ACEI or ARB, and no intervention Patients in primary care with essential hypertension without pre-existing CVD, HF or diabetes; divided into different cohorts by age, sex and baseline cardiovascular risk, heart failure risk and diabetes risk Primary care, UK Cost-utility analysis Favoured CCB (associated with low risk of diabetes and cardiovascular disease) and diuretics (for those at high risk of heart failure); BB is the least favoured
The potential savings of using thiazides as first choice antihypertensive drug: Cost-minimization analysis (Fretheim et al. [23]) Thiazides, BB, CCB, ACEI, angiotensin II antagonists, alpha blocking agents Survey-based estimates of the proportion of the adult population treated for hypertension in Canada, England, France, Norway, the US and Germany. Canada, France, Germany, Norway, the UK and the US. Cost-minimization analysis, thus assumes equal efficacy and tolerability Favoured thiazide diuretics
Cost-effectiveness of Chlorthalidone, Amlodipine and Lisinopril as First-Step Treatment for Patients with Hypertension: An Analysis of the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) (Heidenreich et al. [24]) Chlorthalidone (diuretic), lisinopril (ACEI), amlodipine (CCB) Patients 55 years old or greater with hypertension and at least 1 additional risk factor for coronary heart disease USA Cost-effectiveness analysis Favoured diuretics (chlorthalidone)
Economic evaluation of four angiotensin II receptor blockers in the treatment of hypertension (Miller et al. [25]) Olmesartan, losartan, valsartan and irbesartan 121,472 patients diagnosed with hypertension, aged 18 years or older; four cohorts based on drug used Managed care setting, USA Cost-effectiveness analysis with decision-analytic approach Favoured olmesartan compared to the other ARBs
Evaluation of the awareness, control and cost-effectiveness of hypertension treatment in a Brazilian city: A populational study (Moreira et al. [26]) Diuretics, BB, ACEI, ACEI and diuretics, diuretics and BB, other medications Sample representative of the adult urban population of Sao Paolo State, Brazil, 40 years or more; sample stratified by age groups and classified according to blood pressure level; study included 1492 individuals. Brazil Cost-effectiveness analysis in a randomized and cross-sectional populational study Favoured diuretics
Analisis de costes farmacologicos en el tratamiento de la hipertension arterial: Aproximacion a un studio coste-efectividad (Moreno [27]) Comparison between ACE inhibitor, Beta-blocker and Calcium channel blocker 216 patients, 14 years or more; variables (age, sex, SBP, DBP, height, weight, heart rate) and risk factors (smoking history, obesity, hyperlipidemia and diabetes) taken Primary care setting, Spain Cost-effectiveness analysis ACE inhibitor and Calcium channel blocker have greater cost-effectiveness ratio than diuretics. Diuretic was the least costly
Cost-Effectiveness analysis of treatments to reduce cholesterol levels, blood pressure and smoking for the prevention of coronary heart disease: Evaluative study carried out in Spain (Plans-Rubio [28]) Hydrochlorothiazide, nifedipine, propranolol, prazosin, captopril Hypertension patients, mild, moderate severe based on DBP, 40–59 years old Spain Cost-effectiveness analysis Favoured hydrochlorothiazide (diuretic), propranolol (BB) and nifedipine (CCB)
Analysis of Published Economic Evaluations of Angiotensin Receptor Blockers (Theodoratou et al. [29]) Olmesartan, telmisartan, candesartan, irbesartan, losartan and valsartan (all ARB) Hypertension patients uncomplicated and with comorbidities; some populations had diabetes, albuminuria and nephropathy. Studies used came from Japan, USA, UK, Spain, Canada, Switzerland, France, Belgium, Italy, Hungary, Germany, Sweden, Netherlands, Greece and South Africa. Two studies covered EU countries and Asia. Literature review No difference between available ARBs
  1. ACEI – ACE inhibitor; ARB – angiotensin receptor blocker; BB – beta blocker; CCB – calcium channel blocker; DBP – diastolic blood pressure; HDL – high density lipid; LVH – left ventricular hypertrophy; SBP – systolic blood pressure.