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Cost-effectiveness analysis of initial treatment with single-pill combination antihypertensive medications

Journal of Human Hypertension volume 37, pages 985–992 (2023)Cite this article

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Abstract

Hypertension guidelines recommend initiating treatment with single pill combination (SPC) antihypertensive medications, but SPCs are used by only one-third of treated hypertensive US adults. This analysis estimated the cost-effectiveness of initial treatment with SPC dual antihypertensive medications compared with usual care monotherapy in hypertensive US adults.

The validated BP Control Model-Cardiovascular Disease (CVD) Policy Model simulated initial SPC dual therapy (two half-standard doses in a single pill) compared with initial usual care monotherapy (half-standard dose when baseline systolic BP < 20 mmHg above goal and one standard dose when ≥20 mmHg above goal). Secondary analyses examined equivalent dose monotherapy (one standard dose) and equivalent dose dual therapy as separate pills (two half-standard doses). The primary outcomes were direct healthcare costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio (ICER) over 10 years from a US healthcare sector perspective.

At 10 years, initial dual drug SPC was projected to yield 0.028 (95%UI 0.008 to 0.051) more QALYs at no greater cost ($73, 95%UI -$1 983 to $1 629) than usual care monotherapy. In secondary analysis, SPC dual therapy was cost-effective vs. equivalent dose monotherapy (ICER $8 000/QALY gained) and equivalent dose dual therapy as separate pills (ICER $57 000/QALY gained). At average drug prices, initiating antihypertensive treatment with SPC dual therapy is more effective at no greater cost than usual care initial monotherapy and has the potential to improve BP control rates and reduce the burden of CVD in the US.

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Fig. 1: Simulation model schematic.
Fig. 2: Cost-effectiveness of SPC initial dual therapy compared with non-SPC antihypertensive regimens.
Fig. 3: Association of mean medication cost per person-year of treatment with the cost-effectiveness of SPC initial dual therapy vs. non-SPC regimens.

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Data availability

Supplemental methods, tables, and figures can be found in the supplemental material. Additional data and code are available from the corresponding author on reasonable request.

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Funding

AEM was supported by R01HL130500, YZ by R01HL158790, VF by K23HL136899, and BKB by K01HL140170, all from the National Heart, Lung, and Blood Institute (NHLBI) (Bethesda, MD). The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, approval of the article; or decision to submit the article for publication.

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Authors and Affiliations

  1. Columbia University, New York, NY, USA

    Alexis S. Bryan, Andrew E. Moran, Claire M. Mobley, Yiyi Zhang, Steven Shea & Brandon K. Bellows

  2. University of Utah, Salt Lake City, UT, USA

    Catherine G. Derington

  3. University of New South Wales, Sydney, NSW, Australia

    Anthony Rodgers

  4. New York University, New York, NY, USA

    Valy Fontil

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Contributions

ASB and BKB had full access to all data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Detailed author contributions are below. Concept and design: ASB, AEM, and BKB. Acquisition, analysis, or interpretation of data: All authors. Drafting of the article: ASB, AEM, and BKB. Critical revision of the article for important intellectual content: All authors. Approved the final version of the article: All authors. Statistical analysis: ASB, YZ, and BKB. Obtaining funding: AEM and BKB. Administrative, technical, or material support: BKB. Study supervision: BKB.

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Correspondence to Brandon K. Bellows.

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Competing interests

CGD reports research funds to her institution from Amarin Pharma, Inc. AR is employed by The George Institute for Global Health (TGI) and Imperial College London. He is seconded part-time to George Medicines Pty Ltd (GM), which is partly owned by George Health Enterprises (GHE), the social enterprise arm of TGI. TGI holds patents for ultra-low-dose fixed-dose combination products for the treatment of hypertension and diabetes, and AR is listed as one of the inventors (US 10,369,15; US 10,799,487; US 10,322,117; US 11,033,544). GHE and GM have received funding from public and private investors to conduct the research required for regulatory approval of cardiovascular combination products. AR does not have a financial interest in these patent applications or investments.

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Bryan, A.S., Moran, A.E., Mobley, C.M. et al. Cost-effectiveness analysis of initial treatment with single-pill combination antihypertensive medications. J Hum Hypertens 37, 985–992 (2023). https://doi.org/10.1038/s41371-023-00811-3

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