Cost-Utility Analysis of Eprosartan Compared to Enalapril in Primary Prevention and Nitrendipine in Secondary Prevention in Europe—The HEALTH Model

ABSTRACTObjectiveTo investigate the cost-utility of eprosartan versus enalapril (primary prevention) and versus nitrendipine (secondary prevention) on the basis of head-to-head evidence from randomized controlled trials.MethodsThe HEALTH model (Health Economic Assessment of Life with Teveten® for Hypertension) is an object-oriented probabilistic Monte Carlo simulation model. It combines a Framingham-based risk calculation with a systolic blood pressure approach to estimate the relative risk reduction of cardiovascular and cerebrovascular events based on recent meta-analyses. In secondary prevention, an additional risk reduction is modeled for eprosartan according to the results of the MOSES study (“Morbidity and Mortality after Stroke—Eprosartan Compared to Nitrendipine for Secondary Prevention”). Costs and utilities were derived from published estimates considering European country-specific health-care payer perspectives.ResultsComparing eprosartan to enalapril in a primary prevention setting the mean costs per quality adjusted life year (QALY) gained were highest in Germany (€24,036) followed by Belgium (€17,863), the UK (€16,364), Norway (€ 13,834), Sweden (€ 11,691) and Spain (€ 7918). In a secondary prevention setting (eprosartan vs. nitrendipine) the highest costs per QALY gained have been observed in Germany (€9136) followed by the UK (€6008), Norway (€1695), Sweden (€907), Spain (€−2054) and Belgium (€−5767).ConclusionsConsidering a €30,000 willingness-to-pay threshold per QALY gained, eprosartan is cost-effective as compared to enalapril in primary prevention (patients ≥50 years old and a systolic blood pressure ≥160 mm Hg) and cost-effective as compared to nitrendipine in secondary prevention (all investigated patients).