OBJECTIVES : To evaluate cost-effectiveness of olmesartan/amlodipine fix-dose combination (O/A) vs. olmesartan and amlodipine free combination (O+A), amlodipine, and valsartan/amlodipine fix-dose combination (V/A) in treatment of hypertension from payer’s perspective in China.

METHODS : A Markov model was constructed, which included five health states of hypertensive patients initially free of cardiovascular diseases (coronary heart disease (CHD) or stroke, cardiovascular disease (CVD) with acute events, chronic CVD, CVD death, non-CVD death. Clinical data were obtained from a network meta-analysis. Epidemiology data, adverse events (AEs), cost, and utility data were obtained from the literature. The cost associated with AEs was estimated using the cost of same symptoms of hypertensive patients in an electric medical database. The model projected quality-adjusted life years (QALYs) gained, total costs per patient in a 20-year time horizon, and incremental cost-effectiveness ratios (ICERs). One-way and probability sensitivity analysis were conducted for all parameters.

RESULTS : Compared to O+A free combination, amlodipine, and V/A, treatment with O/A led to fewer CVD events and deaths; resulted in an incremental costs of -¥1,719, ¥13,160, ¥6,701 and gained additional QALYs 0.049, 0.089, 0.034 per patient, respectively. When compared with O+A free combination, O/A was dominant. When compared with amlodipine and V/A, the ICERs were below the WHO cost-effectiveness threshold (3 times GDP per capita, ¥198,279, 2018), indicating O/A was a cost-effective option for hypertensive patients in China. The model was most sensitive to the drug costs. Probabilistic sensitivity analysis suggested that the results were robust with 100% and 54.4% probability that O/A was considered cost effective compared with amlodipine and V/A, respectively.

CONCLUSIONS : The study suggests that O/A confer better health outcomes and cost less compared with O+A free combination and is cost-effective compared with amlodipine and V/A to treat hypertension in China.