The Role of Losartan in Cost-effective Hypertension Control

Abstract

Despite recent guidelines emphasising the need for aggressive treatment in patients with elevated blood pressure, the control of hypertension in Europe and the USA is poor, imposing a considerable burden in terms of patient morbidity and mortality, and associated healthcare costs. A major factor contributing to the suboptimal control of hypertension is the failure of patients to adhere to their prescribed therapy. Drug side-effects are an important cause of non-compliance and prescribing a well-tolerated agent that promotes good compliance is therefore the key to the cost-effective management of hypertension. Several studies have demonstrated that patients are more likely to remain on therapy with the angiotensin II antagonist losartan than other antihypertensives. Although the acquisition costs of new antihypertensives such as losartan are greater than for older drugs, such costs represent only a small proportion of the total cost of prescribing antihypertensive therapy. When accessory costs are also considered, the total cost of care with newer antihypertensives is comparable with those for diuretics. The costs involved if therapy has to be switched due to unacceptable side-effects also need to be taken into account when assessing relative cost effectiveness. Furthermore, savings may accrue from the non-haemodynamic benefits of losartan, such as improved cognitive function and renal protection. Further studies will increase awareness of the true cost effectiveness of antihypertensive drugs.

Effectiveness, safety and cost of drug substitution in hypertension

“…The potential impact of poor compliance with therapy is not often taken into account in cost-effectiveness analyses [137]. However, several studies have highlighted the additional resource use and costs incurred by poor adherence to antihypertensives [64,[136][137][138][139][140][141][142][143][144]. Greater compliance with antihypertensive therapy has been shown to be associated with lower costs for physician, hospital and laboratory services [140,143].…”

Losartan: il valore clinico ed economico

“…Nonostante i risultati degli studi clinici condotti negli ultimi trent'anni e le recenti linee guida impongano una terapia aggressiva dell'ipertensione, per le rilevanti riduzioni del rischio cardiovascolare che essa ha dimostrato di indurre, nella pratica il controllo della pressione arteriosa della popolazione è insoddisfacente. Ciò comporta un elevato onere in termini di morbilità e mortalità cardiovascolare e un elevato consumo di risorse sanitarie; la spesa farmaceutica rappresenta solo una parte minore del costo di malattia complessivo dell'ipertensione [22].…”

Angiotensin II Antagonists in the Treatment of Hypertension?Effective and Efficient?

“…However, data from randomized controlled trials do not reflect the usual care situation but a specific study setting. Factors such as patient compliance or medication switch are not taken into consideration [3]. Therefore, modeling techniques are often used to simulate a "real world" combining data from randomized controlled trials with data from epidemiological studies on the natural history of the disease and health care utilization.…”

“…As to the efficiency of AT II antagonist therapy, the few studies available are usually added onto randomized controlled trials assessing costs as secondary endpoint. However, this approach does not take into account the costs of noncompliance, side effects, costs of switching medication or acquisition costs [3]. In addition, economic assessments have to take into account the regional variation of medical care in different health care systems and countries, and results cannot just be transferred from one country to another.…”