Cost-Effectiveness Analysis of Hypertension Treatment: Controlled Release Nifedipine and Candesartan Low-Dose Combination Therapy in Patients with Essential Hypertension —The Nifedipine and Candesartan Combination (NICE-Combi) Study—

Abstract

Societal interest in pharmaco-economic analysis is increasing in Japan. In this study, the cost-effectiveness of low-dose combination therapy with controlled release nifedipine plus candesartan and up-titrated monotherapy with candesartan was estimated, based on the results of the NICE-Combi study. The NICE-Combi study was a double-blind, parallel arm, randomized clinical trial to compare the efficacy of low-dose combination therapy of controlled release nifedipine (20 mg/day) plus candesartan (8 mg/day) vs. up-titrated monotherapy of candesartan (12 mg/day) on blood pressure control in Japanese patients with mild to severe essential hypertension who were not sufficiently controlled by the conventional dose of candesartan (8 mg/day). The incremental cost effectiveness of each cohort during the 8-week randomization period was compared, from the perspective of a third-party payer (i.e., insurers). The average total cost per patient was 29,943 Japanese yen for the combination therapy group and 33,182 Japanese yen for the candesartan monotherapy group, while the rate of achievement of the target blood pressure was significantly higher in the combination therapy group than in the up-titrated monotherapy group. In the combination therapy group, higher efficacy and lower incremental treatment cost (“Dominance”) were observed when compared to the monotherapy group. The sensitivity analyses also supported the results. In conclusion, these results suggest that combination therapy with controlled release nifedipine and low-dose candesartan (8 mg) is “dominant” to up-titrated candesartan monotherapy for the management of essential hypertension. This conclusion was robust to sensitivity analysis.

References

  1. 1

    Chobanian AV, Bakris GL, Black HR, et al: The seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. JAMA 2003; 289: 2560–2572.

  2. 2

    World Health Organization (WHO)/International Society of Hypertension (ISH) : 2003 World Health Organization (WHO)/International Society of Hypertension (ISH) statement on management of hypertension. J Hypertens 2003; 21: 1983–1992.

  3. 3

    World Health Organization (WHO)/International Society of Hypertension (ISH) : 2003 European Society of Hypertension—European Society of Cardiology guidelines for the management of arterial hypertension. J Hypertens 2003; 21: 1011–1053.

  4. 4

    Guidelines Subcommittee : Guidelines for the Management of Hypertension for General Practitioners. Hypertens Res 2001; 24: 613–634.

  5. 5

    Hasebe N, Kikuch K : Controlled Release Nifedipine and Candesartan Low-Dose Combination Therapy in Patients with Essential Hypertension: NICE Combi (Nifedipine and Candesartan Combination) Study. J Hypertens 2005; 23: 445–453.

  6. 6

    Pitt B, Byingto RP, Furberg CD, for the PREVENT Investigators : Effect of amlodipine on the progression of atherosclerosis and the occurrence of clinical events. Circulation 2000; 102: 1503–1510.

  7. 7

    ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group : The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial. Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic: the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). JAMA 2002; 288: 2981–2997.

  8. 8

    Yui Y, Sumiyoshi T, Kodama K, et al: Nifedipine retard was as effective as angiotensin converting enzyme inhibitors in preventing cardiac events in high-risk hypertensive patients with diabetes and coronary artery disease: the Japan Multicenter Investigation for Cardiovascular Diseases-B (JMIC-B) subgroup analysis. Hypertens Res 2004; 27: 449–456.

  9. 9

    Yui Y, Sumiyoshi T, Kodama K, et al, Japan Multicenter Investigation for Cardiovascular Diseases-B Study Group : Comparison of nifedipine retard with angiotensin converting enzyme inhibitors in Japanese hypertensive patients with coronary artery disease: the Japan Multicenter Investigation for Cardiovascular Diseases-B (JMIC-B) randomized trial. Hypertens Res 2004; 27: 181–191.

  10. 10

    Julius S, Kjeldsen SE, Weber M, et al, VALUE trial group : Outcomes in hypertensive patients at high cardiovascular risk treated with regimens based on valsartan or amlodipine: the VALUE randomized trial. Lancet 2004; 363: 2022–2031.

Download references

Author information

Correspondence to Keita Fujikawa.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Fujikawa, K., Hasebe, N. & Kikuchi, K. Cost-Effectiveness Analysis of Hypertension Treatment: Controlled Release Nifedipine and Candesartan Low-Dose Combination Therapy in Patients with Essential Hypertension —The Nifedipine and Candesartan Combination (NICE-Combi) Study—. Hypertens Res 28, 585–591 (2005). https://doi.org/10.1291/hypres.28.585

Download citation

Keywords

  • incremental cost-effectiveness analysis
  • essential hypertension
  • controlled release nifedipine
  • candesartan