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KMID : 1146320140020010026
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Journal of Health Technology Assessment
2014 Volume.2 No. 1 p.26 ~ p.34
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Cost-Effectiveness of Single-Pill Combination Therapy of Amlodipine/Atorvastatin Compared with Concurrent Two-Pill Therapy in Patients with Hypertension in Korea
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Kim Young-Joo
Ko Su-Kyoung
Lee Cheol-Whan
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Abstract
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Objectives: Single-pill combination therapy may be more effective compared with two pill approach in hypertensive patients requiring concomitant statin therapy. We investigated the cost-effectiveness of single-pill amlodipine/atorvastatin (SP) therapy compared with two-pill co-administration (TP) therapy for prevention of cardiovascular disease (CVD) with consideration to adherence in patients with hypertension using simulation model.
Methods: Cohort simulation was performed with 1000 hypertensive patients at an increased risk of CVD or with concomitant dyslipidemia. The efficacy was defined as the number of CVD prevention, which depends on differences in patients’ adherence to each alternative. ‘Adherence’ was defined as compliance to medication over 80% on proportional day covered and ‘non-adherence’ for the remaining. The number of cardiovascular event after TP treatment was based on the Anglo-Scandinavian Cardiac Outcomes Trial-Lipid Lowering Arm (ASCOT-LLA) trial. The proportion of the adherent patient and the cardiovascular outcome differences in adherence level were searched through systematic review. The annual costs of medicine were included according to the adherence levels of each alternative. Average cost-effectiveness ratio (ACER) was calculated as the cost per CVD event prevented in the cohort. All costs were described in 1000 Korean won (KRW).
Results: The number of CVD prevention in SP approach was higher than in TP approach by approximately 1?4 cases. Total annual medication cost with SP approach was 209719?225164 KRW which was lesser than the cost in TP approach, 261893?281993 KRW. ACERs in SP approach were lower than those in TP approach (214?231 KRW vs. 268?298 KRW per prevented CVD event, respectively). SP approach reduced medication cost by around 20% per cardiovascular prevention case than TP approach.
Conclusion: SP approach is cost effective compared with TP approach in hypertensive patients at risk of cardiovascular event or those with concomitant dyslipidemia for CVD prevention.
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KEYWORD
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Single-pill combination, Fixed-dose combination, Atorvastatin, Amlodipine, Adherence, Cardiovascular disease, Cost-effectiveness, Average cost-effectiveness ratio
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