| Objective:The main purpose of the current study is to investigate the long-term economic consequences of candesartan cilexetil?irbesartan and telmisartan in preventing stroke and myocardial infarction(MI)among hypertension patients using Markov model,to provide a basis for the selection of optimized therapeutic schemes,to offer the reference for the domestic hypertension intervention,to assist clinical rational use of drugs.Methods:1.Markov model analysis: A Markov state transition model was built to simulate the dynamic changes of the six states(event free,non-fatal stroke,post stroke,non-fatal MI,post MI,and death)in hypertension patients who received candesartan cilexetil?irbesartan and telmisartan based on the natural history of hypertension with Tree Age Pro2011 software.2.Clinical trials were searched based on these three drugs in the treatment of hypertension,and obtained Markov model transition probability between states combined with Network Meta-analysis.Every health utility values and medical costs were obtained through searching statistical data of China and literature review.3.The roll back analysis,cohort simulation and half-cycle correction were conducted using Markov model to project quality adjusted life years and the health care costs in 20 years for the hypertension patients who had been long-term treated from the societal perspective,and the incremental cost-effectiveness ratio was obtained.A 5% yearly discount rate was applied to both costs and effectiveness.One-way sensitivity analysis,second-order Monte-Carlo simulation and probabilistic sensitivity analysis were performed.Results:1.The baseline roll back analysis showed that the average cost of telmisartan,irbesartan and candesartan cilexetil was 64131.33yuan?64305.32 yuan ? 68273.29 yuan respectively,and obtained 4.57?4.60?4.48 QALYs respectively after antihypertensive therapy for 20 years.Candesartan cilexetil was at an absolute disadvantage because of the highest cost and the lowest effect.The ICER for irbesartan versus telmisartan was 5799.67yuan/QALY.That is,it costs 5799.67 yuan for irbesartan more than telmisartan to get one more QALY.Irbesartan was an advantage scheme compared with the threshold value of 49992 yuan /QALY.2.Markov cohort simulation analysis showed that after 20 Markov model cycles 98.366% patients in candesartan cilexetil model cohort were death,0.784% of whom were post-stroke,patients with post-MI accounted for 0.85%.In irbesartan model cohort 98.063% patients were death,1.078% of whom were post-stroke,patients with post-MI accounted for 0.852%.In telmisartan model cohort 98.127% patients were death,1.042% of whom were post-stroke,patients with post-MI accounted for 0.827%.Irbesartan avoided 303 deaths and telmisartan avoided the death of 239 in every 10000 people compared with candesartan cilexetil.3.The sensitivity analysis was basically consistent with the baseline results,which indicated the robustness of the study.Meanwhile,it showed that the probability of stroke has a decisive impact on the analysis results.The result of the half-cycle correction was consistent with the baseline results.Conclusion:Both irbesartan and telmisartan were able to achieve significant economic effectiveness compared with candesartan cilexetil.And irbesartan showed significant economic advantage compared with telmisartan in the case of limited resources for people aged over 55.Meanwhile,irbesartan prevented more stroke and myocardial infarction events and reduced mortality,suggesting that irbesartan can achieve better health improvement and longer survival time. |
PDF Full Text Request