Author(s)
Andrea F Michaliszyn, BA, DESS, Manager, Health Economics and Pricing1, Amy Lee, Msc, PhD, Senior Analyst2, Shawn J Barry, MA, Associate Director, Analytics2, Larry Leiter, MD, Professor3, Alykhan Nanji, MD, Medical Director4, Lieven Annemans, PhD, MSc, Professor of Health Economics5, Dan Tucker, MD, Health Economist6, Martin Barbeau, BA, MSc, Director, Health Economics and Pricing1, Gábor Vincze, PhD, Health Economist71Novartis Pharmaceuticals Canada Inc, Dorval, QC, Canada; 2 i3 Innovus, Burlington, ON, Canada; 3 University of Toronto, Toronto, ON, Canada; 4 C-era Medical Clinic, Calgary, AB, Canada; 5 Ghent University, Gent, Belgium; 6 IMS Health, Basel, Switzerland; 7 Novartis Pharma AG, Basel, Switzerland
Objective: To determine the cost-utility of aliskiren in combination or monotherapy vs. usual care for patients with mild to moderate hypertension from the Canadian health care system perspective. Methods: A Markov model was programmed to simulate patient flow between 17 health states (including death), different treatment lines and allowing for non-persistence. Cardiovascular disease (CVD) related outcomes were projected for over 40 years from systolic blood pressure (SBP) reductions observed in several randomized trials using risk equations from landmark studies, including the Framingham Heart Study. Patients were at low risk of CVD, based on their demographic and clinical history at baseline. The following comparisons were analyzed: aliskiren + thiazide-diuretic vs. ACEI + thiazide-diuretic, ARB + thiazide-diuretic, and CCB + thiazide-diuretic, aliskiren + CCB vs. thiazide-diuretic + CCB, and aliskiren vs. ARB. Direct costs for health states and events were taken from published literature. Weighted average unit prices were obtained for each antihypertensive drug class. All costs are in 2007 CAD. The primary outcome was incremental cost per additional quality-adjusted life-year QALY. Additional outcomes included life expectancy and number of CVD-related deaths. Results: Aliskiren + thiazide-diuretic was shown to be dominant vs. CCB + thiazide-diuretic, cost-effective in monotherapy vs. ARB ($1,011/QALY) and cost-effective when in combination therapy with CCB vs. thiazide-diuretic + CCB ($29,813/QALY). More variability occurred when comparing aliskiren + thiazide-diuretic to ARB + thiazide-diuretic (ranging from dominance to being dominated). Based on pooled data of aliskiren vs. ARBs showing similar SBP-lowering effect, the cost impact of aliskiren is expected to be neutral, given equivalent unit prices with ARBs. Most results were robust to changes in underlying model settings and parameters, and in the range of acceptable values for healthcare interventions. Conclusion: Compared to several standard antihypertensives, aliskiren provides good value for money, and in some cases, results in cost savings and better outcomes.
Conference/Value in Health Info
2008-05, ISPOR 2008, Toronto, Ontario, Canada
Value in Health, Vol. 11, No. 3 (May/June 2008)
Code
PCV54
Topic
Economic Evaluation
Topic Subcategory
Cost-comparison, Effectiveness, Utility, Benefit Analysis
Disease
Cardiovascular Disorders
