Comparative Economic and Clinical Utility of Adding Candesartan for Hypertension Management
Main Article Content
Abstract
Introduction: Antihypertensive drugs require high costs because they are used over a long period. Therefore, consideration is needed in drug selection requirements, effectiveness, and price. This study aimed to see the beneficial results of hypertension therapy and the non-medical costs incurred by patients using cost-utility analysis (CUA). Method: This research was a prospective study. The incremental Cost-Utility Ratio (ICUR) of antihypertensive treatment was calculated using cost-utility data obtained through EQ-5D-5L questionnaires from outpatients at Universitas Andalas Hospital in January- March 2023 who met the inclusion and exclusion criteria. The costs used were from a patient perspective, consisting of direct medical and non-medical costs. This study compared standard treatment (amlodipine) with the addition of candesartan. Results: The number of respondents in this study was 67, consisting of 23 respondents (34.33%) using amlodipine alone and 44 respondents (65.67%) using the amlodipine-candesartan combination. The ICUR value obtained was IDR7,318,674/QALY. The difference in the average utility value of the amlodipine-candesartan combination with amlodipine alone is -0.02, and the difference in cost is -IDR12,224. Based on the cost-utility diagram, the amlodipine-candesartan combination group is included in the southwest quadrant (quadrant III), which illustrates that the cost required for the amlodipine-candesartan combination group is lower than the cost of the amlodipine single treatment group and the outcome is also not better (slightly lower or the same). Conclusion: It was recommended to prioritize using amlodipine alone for hypertension management, as it provides similar outcomes to the amlodipine-candesartan combination while incurring lower costs.
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References
. Mills KT, Stefanescu A, He J. The global epidemiology of hypertension. Nat Rev Nephrol. 2020;16(4):223–37. https://doi.org/10.1038/s41581-019-0244-2
. World Health Organization (WHO). Guideline for the pharmacological treatment of hypertension in adults. Vol. 01, Universitas Nusantara PGRI Kediri. World Health Organization; 2021. 1–61 p.
. James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J, et al. 2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults: Report From the Panel Members Appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014;311(5):507–20. https://doi.org/10.1001/jama.2013.284427
. Mancia G, Rea F, Corrao G, Grassi G. Two-Drug Combinations as First-Step Antihypertensive Treatment. Circ Res. 2019;124(7):1113–23. https://doi.org/10.1161/CIRCRESAHA.118.313294
. Bilen O, Wenger NK. Hypertension management in older adults. F1000Research. 2020;9. https://doi.org/10.12688/f1000research.20323.1
. Turana Y, Tengkawan J, Soenarta AA. Asian management of hypertension: Current status, home blood pressure, and specific concerns in Indonesia. J Clin Hypertens (Greenwich). 2020;22(3):483–5. https://doi.org/10.1111/jch.13681
. Fitria N, Sari YO, Ananta FT, Husnia K. Adherence Assessment on Hypertension Therapy Using The Pill Count Method in Lubuk Kilangan Health Center , Indonesia. J Sains Farm Klin. 2023;69–75. https://doi.org/10.25077/jsfk.10.1.69-75.2023
. Fitria N, Syaputri YZ, Akram M. Amlodipine-Candesartan Combination : A Cost-Effective Strategy for Successful Therapy of Hypertension. J Sains Farm Klin. 2024;11(1):32–8. https://doi.org/10.25077/jsfk.11.1.32-38.2024
. Reenen M van, Janssen B, Stolk E, Boye KS, Herdman M, Kennedy-Martin M, et al. EQ-5D-5L User Guide. Basic information on how to use the EQ-5D-5L instrument. EuroQol Research Foundation; 2021.
. Purba FFD, Hunfeld JAMJ, Iskandarsyah A, Fitriana TTS, Sadarjoen SSS, Ramos-Goñi JJM, et al. The Indonesian EQ-5D-5L Value Set. Pharmacoeconomics. 2017;35(11):1153–65. https://doi.org/10.1007/s40273-017-0538-9
. Idrus LRL, Fitria N, Purba FFD, Alffenaar J-WC, Postma MMJ, Allffenaar J, et al. Analysis of Health-Related Quality of Life and Incurred Costs Among Human Immunodeficiency Virus, Tuberculosis, and Tuberculosis/HIV Coinfected Outpatients in Indonesia. Value Heal Reg issues. 2024;41:32–40. https://doi.org/10.1016/j.vhri.2023.10.010
. Saptaningsih AB, Setiawan D, Rivany R, Aryandono T, Atthobari J, Dwiprahasto I. The Development of Quality of Life Questionnaire for Indonesian Breast Cancer Patients: INA-BCHRQoL. Asian Pac J Cancer Prev. 2018;19(5):1269–75. https://doi.org/10.22034/APJCP.2018.19.5.1269
. Oemar M, Janssen B. EQ-5D-5L User Guide. Basic information on how to use the EQ-5D-5L instrument. EuroQol Group; 2013.
. Alava M, Wailoo A, Grimm S, Pudney S, Gomes M, Sadique Z, et al. EQ-5D-5L Versus EQ-5D-3L: The Impact On Cost Effectiveness In The United Kingdom. Value Heal. 2018;21(1):49–56. https://doi.org/10.1016/j.jval.2017.09.004
. Kouwenberg C, Kranenburg L, Visser M, Busschbach J, Mureau M. The Validity Of The EQ-5D-5L In Measuring Quality Of Life Benefits Of Breast Reconstruction. J Plast Reconstr Aesthetic Surg. 2019;72(1):52–61. https://doi.org/10.1016/j.bjps.2018.08.023
. Sohn IS, Kim C-J, Ahn T, Youn H-J, Jeon H-K, Ihm SH, et al. Efficacy and Tolerability of Combination Therapy Versus Monotherapy with Candesartan and/or Amlodipine for Dose Finding in Essential Hypertension: A Phase II Multicenter, Randomized, Double-blind Clinical Trial. Clin Ther. 2017;39(8):1628–38. https://doi.org/10.1016/j.clinthera.2017.06.014
. Tonin F, Aznar-Lou I, Pontinha V, Pontarolo R, Fernandez-Llimos F. Principles Of Pharmacoeconomic Analysis: The Case Of Pharmacist-Led Interventions. Pharm Pract (Granada). 2021;19(1):1–10. https://doi.org/10.18549/PharmPract.2021.1.2302
. Fitria N, Wulansari S, Sari YO. Potential Interactions Analysis of Antihypertensive Drugs Used in Geriatric. Int J Appl Pharm. 2023;15(Special Issue 1):29–33. https://doi.org/10.22159/ijap.2023.v15s1.47503
. Ravangard R, Jalali FS, Hajahmadi M, Jafari A. Cost-utility analysis of valsartan, enalapril, and candesartan in patients with heart failure in Iran. Health Econ Rev. 2023;13(1):44. https://doi.org/10.1186/s13561-023-00457-4
. Schäfer HH, Scheunert U. Costs of current antihypertensive therapy in Switzerland: an economic evaluation of 3,489 patients in primary care. Swiss Med Wkly. 2013;143:w13854. https://doi.org/10.4414/smw.2013.13854
. Renee JA. Pharmacoeconomics From Theory to Practice. Second. Renée JGA, editor. Oxon: CRC Press; 2021. 335 p.
. Park C, Wang G, Durthaler JM, Fang J. Cost-effectiveness Analyses of Antihypertensive Medicines: A Systematic Review. Am J Prev Med. 2017;53(6S2):S131–42. https://doi.org/10.1016/j.amepre.2017.06.020
. Husereau D, Drummond M, Augustovski F, de Bekker-Grob E, Briggs AH, Carswell C, et al. Consolidated Health Economic Evaluation Reporting Standards 2022 (CHEERS 2022) Statement: Updated Reporting Guidance for Health Economic Evaluations. Value Heal. 2022;25(1):3–9. https://doi.org/10.1016/j.jval.2021.11.1351