An Economic Evaluation of the 2003 European Society of Hypertension–European Society of Cardiology Guidelines for the Management of Mild-to-Moderate Hypertension in Greece

Background In the 2003 European Society of Hypertension–European Society of Cardiology (ESH-ESC) guidelines, it is concluded that the major classes of antihypertensive agents are suitable for the initiation and maintenance of antihypertensive therapy. The aim of this study was to compare the cost-effectiveness of each one of the major antihypertensive agents as monotherapy in the management of mild-to-moderate hypertension in Greece, when following the 2003 ESH-ESC guidelines. Methods We performed a cost-effectiveness analysis based on numbers needed to treat. A decision analysis model was developed to compare chlorthalidone, propranolol, amlodipine, enalapril and losartan. Clinical inputs were derived from a meta-analysis and randomized controlled trials and cost data from public sources. The evaluation of the cost of managing hypertension includes the cost of drug therapy, monitoring, treating side effects, poor compliance and switching. All costs were calculated from a public insurance system perspective, in 2004 Euros. Future costs and clinical benefits were discounted at 5%. The time frame was 5 years. Extensive sensitivity analyses were also performed. Results The cost (in Euros) of uncomplicated hypertension treatment for 5 years was 485.87, 567.66, 851.44, 607.45, and 1279.88 for chlorthalidone, propranolol, amlodipine, enalapril, and losartan, respectively. The estimated total cost (in Euros) to prevent one death was 60230.71, 70369.96, 105596.72, 75301.40, and 158659.35, respectively. Conclusions In mild-to-moderate uncomplicated hypertension chlorthalidone is the most cost-effective agent. If it was the drug of choice to initiate treatment of uncomplicated hypertension, it would probably save the public insurance system organizations a great amount of expenses for benefit of the insured patients.