Abstract
As recommended by the guidelines such as JSH 2004, combination therapy with multiple agents is now being applied to many patients with hypertension. However, a pharmacoeconomic analysis of each therapy has not been fully undertaken in Japan, despite increasing societal interest. In this study, the cost-effectiveness of two calcium channel blockers, each coadministered with an angiotensin receptor blockade, was compared using data from the ADVANCE-Combi study. The ADVANCE-Combi study was a 16-week doubleblind, randomized clinical trial to compare the efficacy and safety of two combination therapies (controlledrelease nifedipine [nifedipine CR] plus valsartan vs. amlodipine plus valsartan) on blood pressure (BP) control in patients with moderate to severe essential hypertension. The incremental cost effectiveness of each cohort was compared from the perspective of insurers. The average total cost per patient was Japanese yen (JPY) 31,615 for the nifedipine CR treatment group and JPY 35,399 for the amlodipine treatment group (p<0.001). The achievement rate of the target BP (SBP/DBP<130/85 mmHg for patients aged under 60 years; SBP/DBP<140/90 mmHg for those aged 60 years and over) was significantly higher in the nifedipine CR treatment group (61.2%) than in the amlodipine treatment group (34.6%) (p<0.001), with no difference in the incidence of drug-related adverse events. Accordingly, the base case economic analysis demonstrated that the nifedipine CR treatment group was dominant (more efficacious and less costly) to the amlodipine treatment group. This result was supported by univariate and probabilistic sensitivity analyses.These results indicate that nifedipine CR-based combination therapy is superior to amlodipine-based combination therapy for the management of essential hypertension in the Japanese population.
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Staessen JA, Fagard R, Thijs L, et al, Systolic Hypertension in Europe (Syst-Eur) Trial Investigators: Randomized double-blind comparison of placebo and active treatment for older patients with isolated systolic hypertension. Lancet 1997; 350: 757–764.
Hansson L, Zanchetti A, Carruthers SG, et al, HOT Study Group: Effects of intensive blood pressure lowering and low-dose aspirin in patients with hypertension: principal results of the Hypertension Optimal Treatment (HOT) randomized trial. Lancet 1998; 351: 1755–1762.
The ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group: 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. JAMA 2002; 288: 2981–2997.
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.
Staessen JA, Li Y, Thijs L, Wang JG : Blood pressure reduction and cardiovascular prevention: an update including the 2003–2004 secondary prevention trials. Hypertens Res 2005; 28: 385–407.
Japanese Society of Hypertension: Japanese Society of Hypertension Guidelines for the Management of Hypertension (JSH 2004). Hypertens Res 2006; 29 ( Suppl): S1–S105.
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.
2003 World Health Organization (WHO)/ International Society of Hypertension (ISH) statement on management of hypertension. J Hypertens 2003; 21: 1983–1992.
Mancia G, De Backer G Dominiczak et al: 2007 Guidelines for the Management of Arterial Hypertension: the Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens 2007; 25: 1105–1187.
Mori H, Ukai H, Yamamoto H, et al: Current status of antihypertensive prescription and associated blood pressure control in Japan. Hypertens Res 2006; 29: 143–152.
Saito I, Kobayashi M, Matsushita Y, Saruta T : Pharmacoeconimical evaluation of combination therapy for lifetime hypertension treatment in Japan. JMAJ 2005; 48: 574–585.
Hasebe N, Kikuchi 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.
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 2005; 28: 585–591.
Saito I, Saruta T : Controlled release nifedipine and valsartan combination therapy in patients with essential hypertension: the Adalat CR and Valsartan Cost-Effectiveness Combination (ADVANCE-Combi) Study. Hypertens Res 2006; 29: 789–796.
Japanese Society of Hypertension Guidelines Subcommittee for the Management of Hypertension: Guidelines for the management of hypertension for general practitioners. Hypertens Res 2001; 24: 613–634.
Turnbull F, Blood Pressure Lowering Treatment Trialists' Collaboration: Effects of different blood-pressure—lowering regimens on major cardiovascular events: results of prospective-designed overviews of randomised trials. Lancet 2003; 362: 1527–1535.
Lubsen J, Wagener G, Kirwan BA, de Brouwer S, Poole-Wilson PA : Effect of long-acting nifedipine on mortality and cardiovascular morbidity in patients with symptomatic stable angina and hypertension: the ACTION trial. J Hypertens 2005; 23: 641–648.
Murai K, Obara T, Ohkubo T, et al: Current usage of diuretics among hypertensive patients in Japan: the Japan Home versus Office Blood Pressure Measurement Evaluation (JHOME) Study. Hypertens Res 2006; 29: 857–864.
Hoshide S, Kario K, Ishikawa J, Eguchi K, Shimada K : Comparison of the effects of cilnidipine and amlodipine on ambulatory blood pressure. Hypertens Res 2005; 28: 1003–1008.
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Saito, I., Fujikawa, K., Saruta, T. et al. Cost-Effectiveness Analysis: Controlled-Release Nifedipine and Valsartan Combination Therapy in Patients with Essential Hypertension: The Adalat CR and Valsartan Cost-Effectiveness Combination (ADVANCE-Combi) Study. Hypertens Res 31, 1399–1405 (2008). https://doi.org/10.1291/hypres.31.1399
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DOI: https://doi.org/10.1291/hypres.31.1399