OBJECTIVES:

Recent evidence suggests that single-pill combination (SPC) could decrease blood pressure to a greater extent than free-equivalent combination (FEC), notably by virtue of better adherence. We examined to what extent this greater blood pressure reduction is cost-effective within the Italian healthcare setting.

METHODS:

A Markov model was designed to project over a lifetime horizon the number of Major Cardiovascular Events (MaCEs), Life Years (LYs), Quality-adjusted Life Years (QALYs) and the direct medical costs. The incidence of MaCEs was projected using the fitted linear relationship between Systolic BP (SBP) reduction and risk of MaCEs from the meta-regression reported by the Blood Pressure Lowering Treatment Trialists’ Collaboration. SBP reductions achieved by each treatment strategy were informed by a random effect meta-analysis. Italian healthcare costs were informed from literature. For treatment acquisition costs, we used the price of Triplixam®, a triple single-pill combination of perindopril, indapamide and amlodipine. We assumed price parity of FEC in the base case analysis.

RESULTS:

Considering a cohort of 1,000 patients projected over their lifetime, the SPC avoided 33 MaCEs (- 7.0%) and 2 CV death as compared to its FEC. This led to +0.084 LY and +0.062 QALY gained for SPC, respectively. These health benefits were associated with cost savings. SPC saved €655 of direct medical cost per patient over lifetime because of the lowered incidence of MaCEs. Hence, cost-effectiveness analysis revealed dominance of SPC versus FEC. The incremental net monetary benefit of SPC over FEC was +€1,896 (for a WTP of €20,000/QALY). The results were robust to sensitivity analysis.

CONCLUSIONS:

SPC is cost-effective versus its FEC in the management of hypertension and prevention of MaCEs and CV deaths.