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A Cost-Utility Analysis of Losartan versus Atenolol in the Treatment of Hypertension with Left Ventricular Hypertrophy

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Abstract

Introduction: The LIFE (Losartan Intervention For Endpoint reduction in hypertension) study demonstrated a 13% relative risk reduction in the primary composite endpoint (myocardial infarction, stroke or death) for patients with hypertension and electrocardiographically diagnosed left ventricular hypertrophy (LVH) treated with losartan compared with atenolol. Losartan recipients also had a 25% relative risk reduction for stroke compared with atenolol recipients. Incorporating the results found in the LIFE study into an economic model, an incremental cost-effectiveness analysis was performed comparing losartan with atenolol in the treatment of 67-year old patients with hypertension and LVH.

Methods: A Markov state transition model, based on published results of the LIFE trial (mean follow-up of 4.8 years), was utilised to extrapolate the outcomes observed in this trial to the patients’ lifetime. Utility estimates for the associated health states were obtained from various published sources. Lifetime treatment costs were calculated adopting a societal perspective. Both costs and benefits were discounted and incremental cost-effectiveness ratios (ICERs) were estimated. One-way and probabilistic sensitivity analyses were performed.

Results: The estimated ICER for losartan versus atenolol was $Can1337 per QALY gained ($Can1 = $US0.75, 2002 values). This ICER was robust to extensive sensitivity analysis, demonstrating a 95% probability that the ICER would be <$Can20 000 per QALY gained.

Conclusion: From a Canadian societal perspective, losartan appears to be a cost-effective alternative to atenolol in patients with hypertension and LVH. The estimated ICERs, including the sensitivity analyses, were within the range of cost-effectiveness ratios for various currently funded interventions and drugs in developed countries.

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Acknowledgements

Marc Brisson is an employee of Merck Frosst, Canada. The authors have no other conflicts of interest to report. Unconditional funding for this research was provided by Merck Frosst, Canada.

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Authors and Affiliations

  1. Department of Health Care and Epidemiology, University of British Columbia, Vancouver, British Columbia, Canada

    Aslam H. Anis

  2. Centre for Health Evaluation and Outcome Studies, Vancouver, British Columbia, Canada

    Aslam H. Anis, Huiying Sun, Sonia Singh & Bohdan Nosyk

  3. Peace Arch Hospital, White Rock, British Columbia, Canada

    Sonia Singh

  4. British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada

    John Woolcott

  5. Merc Frosst Canada Ltd, Kirkland, Quebec, Canada

    Marc Brisson

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  1. Aslam H. Anis
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Correspondence to Aslam H. Anis.

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Anis, A.H., Sun, H., Singh, S. et al. A Cost-Utility Analysis of Losartan versus Atenolol in the Treatment of Hypertension with Left Ventricular Hypertrophy. Pharmacoeconomics 24, 387–400 (2006). https://doi.org/10.2165/00019053-200624040-00008

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