A COST COMPARISON STUDY OF AMLODIPINE AND ENALAPRIL IN THE TREATMENT OF HYPERTENSION IN EUROPE

OBJECTIVES: To compare the treatment costs of amlodipine versus enalapril in the treatment of mild to moderate hypertension in France, Italy, Germany, Spain and Sweden. METHODS: A post-hoc analysis was performed by examining the patient-level data from a one-year, double-blind clinical trial of amlodipine (n=231) versus enalapril (n=230). We determined the frequency and dosage of antihypertensives administered longitudinally in both treatment arms. The analysis also compared the adverse event profiles and efficacy rates in each treatment group. Ex-factory costs of amlodipine, enalapril, and the diuretic, hydrochlorothiazide (HCTZ), were obtained for all countries. The net costs of treatment were calculated within trial phases and throughout the 50-week trial period. RESULTS: In all the countries evaluated, the average treatment costs in the amlodipine group were less expensive than those in the enalapril group producing a cost savings over the trial duration ranging from 2% ($2.81) in Spain to 32% ($81) in France. The mean final visit drug dosages per patient were 7.2 mg/day for amlodipine and 28 mg/day for enalapril. The total reduction in sitting DBP was not significantly different between treatment groups; however, significantly more patients (p<0.05) in the enalapril group (n=46, 20%) required the use of HCTZ to attain control of DBP than in the amlodipine group (n=27, 11.7%). Finally, there were no significant differences (p<0.05) in adverse events between groups. CONCLUSION: Healthcare providers should favor utilization of amlodipine over enalapril as a less expensive and equally effective means of achieving blood pressure control in the mild to moderate hypertensive populations of Europe.