| Objective:In this study,valsartan amlodipine(VA),temisartan amlodipine(TA),and olmesartan amlodipine(OA)were comprehensively evaluated in terms of safety,efficacy,and economy from the perspective of Chinese health system through network meta-analysis and cost-utility analysis.It provides evidence for clinicians to choose the optimal treatment plan and provides theoretical basis for medical decision making.Method:(1)Network meta-analysis:Chinese and English databases such as CNKI,Wanfang,PubMed and Embase were searched,the randomized controlled clinical trial(RCT)groups retrieved were valsartan amlodipine(VA),temisartan amlodipine(TA)or olmesartanate amlodipine(OA),and the control group was amlodipine(A5)or(and)placebo.Eligible literature was included and evaluated for literature quality using Revman 5.4 software,and for efficacy and safety using STATA 16.0 software.(2)Cost-utility analysis:Changes in the five states of event-free,nonfatal stroke,nonfatal myocardial infarction,unnatural death,and natural death in hypertensive patients treated with three drugs,VA,TA,and OA,were simulated separately based on Markov models.Costs were calculated using a 5%discount rate with a half-cycle correction;the total costs and long-term health outputs of the three treatment options were calculated by roll back analysis;otherwise,a decision analysis of their economics was performed.Cost data and disease transfer probabilities for the input model were obtained from the literature,and costs were converted by the Consumer Price Index(CPI)for each year,both natural death probabilities and CPI were obtained from the National Institute of Statistics.(3)Sensitivity analysis:① The cost of each state of different interventions was adjusted according to the baseline±20%,the health utility value and drug cost were adjusted according to the baseline±10%,the transfer probability was adjusted according to the baseline±5%,and the discount rate was adjusted by 0～8%to explore the extent of their effects on the results,which were expressed as tornado plots.②In the probabilistic sensitivity analysis,the parameters were set in a specific distribution and the robustness of the results was verified by Monte Carlo simulations.Results:(1)Network meta-analysis:12 RCTs were finally included,with a total of 5563 patients.The results showed that there was no statistical difference in heterogeneity between studies(P>0.05),so the consistency model was used for analysis;in terms of lowering systolic blood pressure,TA and OA were significantly better than VA,while there was no significant difference between TA and OA.In terms of lowering diastolic blood pressure,there was no statistical difference between the three compounding groups,but they were significantly better than the placebo and amlodipine groups.In terms of adverse effects,there was no significant difference between the three groups of compounded formulations and amlodipine,the main adverse effects were edema,dizziness and hypotension,which were within the tolerable range of patients.(2)Cost-utility analysis:After 30 years of simulation,the QALY of OA group,TA group and VA group were 7.75,7.72 and 7.37,respectively,and the corresponding total cost was ￥119790.23,￥120424.38 and ￥134645.45.The absolute NMBs of the three groups were ￥507773.77,￥504710.34 and ￥462147.67.indicating that the olmesartan amlodipine group was favorable.(3)The sensitivity analysis was consistent with the baseline results and verified the robustness of the results.Conclusion:In patients with essential hypertension uncontrolled by a single antihypertensive agent,there was no difference in the short-term reduction of diastolic blood pressure between olmesartan ester amlodipine and temisartan amlodipine,but the reduction of systolic blood pressure was superior to that of temisartan amlodipine,which was more economical when combined with the results of long-term pharmacoeconomic evaluations. |
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