The Potential Economic Consequences of Cognitive Improvement with Losartan

Abstract

In a clinical trial, treatment of mild-moderate hypertensive patients with losartan (50 mg) increased Mini-Mental State Examination (MMSE) scores by 4 points from baseline over a 26-month period, compared with a 1-point increase in patients treated with hydrochlorothiazide (25 mg). This study explores the potential economic consequences of this improvement in cognitive function in a population of elderly hypertensive patients in Sweden. Resource use and MMSE data for 437 hypertensive, non-demented subjects aged 75 years and above, were taken from a population-based study in Sweden. MMSE scores were strongly related with costs of care due to higher utilization of home help and special living arrangements in patients with low scores. A 1-point difference in MMSE was associated with a difference in the annual cost of care of approximately 5700 Swedish kronor (SEK). Over 26 months, the potential cost savings from the 4-point improvement observed with losartan was estimated to be between 24700 and 43700 SEK. This can be compared with the acquisition cost of losartan; approximately 5700 SEK over the study period. Thus, an improvement in cognitive function of the magnitude documented in the study of losartan vs hydrochlorothiazide, may translate into economic benefits beyond those expected in terms of blood pressure control.

Cognitive enhancement following acute losartan in normotensive young adults

“…In human studies, the Losartan Intervention For Endpoint Reduction study (Dahlof et al 2002), the Valsartan Antihypertensive Long-term Use Evaluation study (Julius et al 2004) and the Candesartan in Heart Failure Assessment on Reduction in Mortality and Morbidity study (McMurray et al 1993) reported quality of life (QoL) enhancements following antihypertensive therapy using AIIAs. These were confirmed by further studies, in addition to improved Mini-Mental State Examination (MMSE) scores (Tedesco et al 1999;Jönsson et al 2002;Hanon et al 2008) and improved acquisition and recall (Fogari et al 2003(Fogari et al , 2004(Fogari et al , 2006 in older patients with hypertension. Additionally, Saxby et al (2008) reported that chronic treatment (44 weeks) with candesartan produced protective effects against the deterioration of episodic memory in older patients with hypertension when compared to placebo-treated age-matched patients.…”

Blockade of the renin–angiotensin–aldosterone system: a key therapeutic strategy to reduce renal and cardiovascular events in patients with diabetes

“…In a separate study, Jonsson et al [165] also found that the cognitive improvement associated with losartan treatment of elderly hypertensive patients in Sweden translated into potential economic benefits beyond blood pressure control. Over 26 months, the 4-point improvement in Mini-Mental State Examination scores in losartan-treated patients (compared with a 1-point increase in hydrochlorothiazide-treated patients) was estimated to result in cost savings between SEK24 700 and SEK43 700, a value comparable with the losartan acquisition cost during the treatment period.…”

Losartan: il valore clinico ed economico

“…La possibilità di prevenire efficacemente eventi clinici importanti in soggetti ad alto rischio non è solo un benvenuto progresso clinico, ma ha la potenzialità di incidere sui costi sanitari complessivi delle patologie cardiovascolari. Ciò è stato dimostrato per quanto riguarda il rallentamento della progressione della nefropatia diabetica, in più contesti sanitari, ed è ipotizzabile per altre patologie ad alto impatto economico, il cui rischio viene ridotto da losartan, come gli ictus (LIFE), lo scompenso cardiaco che necessita di ricovero (ELITE, RENAAL), il deterioramento cognitivo [23], l'insorgenza di nuovi casi di diabete.…”