Saturday, June 22, 2024

Cost-Effectiveness of Single-Pill Combination for Hypertension in Italy

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A recent evaluation has highlighted the significant economic and health benefits of using a single-pill combination (SPC) of perindopril, amlodipine, and indapamide for treating hypertension in Italy. The analysis, based on a comprehensive Markov model, underscores the SPC’s superior cost-effectiveness when compared to the free equivalent combination (FEC). This study, conducted from the perspective of the Italian healthcare payer, suggests that the SPC not only reduces costs but also enhances patient outcomes by decreasing the risk of cardiovascular events and chronic kidney disease (CKD).


The study employed a Markov model to perform a cost-utility analysis over a lifetime horizon. This model translated the additional blood pressure-lowering effect of the SPC into a decreased risk of cardiovascular events and CKD using Framingham risk algorithms. Moreover, differences in persistence rates between the SPC and FEC were incorporated into the model through discontinuation rates, providing a more accurate reflection of real-world adherence and its impact on health outcomes.

Key Findings

The results of the analysis indicated that the perindopril/amlodipine/indapamide SPC is associated with better health outcomes and lower costs compared to its FEC counterpart. Specifically, over a lifetime horizon, the SPC resulted in a 0.050 quality-adjusted life year (QALY) gain and cost savings of €376, primarily due to reduced cardiovascular event rates. In an alternative scenario considering different adherence modeling, the incremental gain increased to 0.069 QALY with savings of €1,004. These findings were consistent across various sensitivity and scenario analyses, reinforcing the robustness of the cost-effectiveness of the SPC.

User-Usable Inferences

  • The SPC of perindopril, amlodipine, and indapamide offers significant cost savings and health benefits over a lifetime compared to the FEC.
  • SPC usage can lead to lower rates of cardiovascular events and CKD, enhancing patient quality of life.
  • Healthcare providers can consider the SPC as a cost-effective strategy for managing hypertension in Italy.
  • Patient adherence to medication regimens is crucial, and SPC formulations may improve persistence rates.

In conclusion, the study provides compelling evidence that the perindopril/amlodipine/indapamide SPC is a cost-effective and health-beneficial treatment option for hypertension in Italy. These results can inform healthcare policies and treatment strategies, potentially leading to better patient outcomes and more efficient use of healthcare resources.

Original Article: Expert Rev Pharmacoecon Outcomes Res. 2024 Jun 7. doi: 10.1080/14737167.2024.2365988. Online ahead of print.

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