| Objective:The clinical efficacy and safety of amlodipine, compound amiloride and telmisartan that can cure essential hypertension was observed. Meanwhile the method of pharmacoeconomics was used to evaluate the economic cost and the effect of the two combined antihypertensive drugs.Methods:The purposive sampling was used in this study.100 patients from Xianjia and Westlake, two communities of Changsha in Hunan Province, which tally with the criteria of essential hypertension were selected as a case study, from January 1,2008 to December 31,2008. The patients were randomly distributed to combine antihypertensive therapy group A (amlodipine and compound amiloride) and group B (amlodipine and telmisartan). The patients were interviewed for a year to observe the pressure, heart rate, biochemical indicator, untoward effect, outcome event and so on, while the effect, cost and the influence factors were analyzed. We use the cost-effectiveness to evaluate the drug economics of different antihypertensive treatment combined assessment to calculate proportion of cost and effect according to different effectiveness indicator to make incremental cost-effectiveness and sensitivity analysis.Results:1. Analysis of Effect(1) The SBP of combined group A and B decreased to (26.4±16.0) mmHg and (30.6±15.6) mmHg respectively; while the DBP (10.2±9.2) mmHg and (11.3±11.0) mmHg. The antihypertensive efficacy of the two groups'drug was 81.3% and 89.6%; significant effective rate was 50.0% and 68.8%; compliance rates were 79.1% and 87.5%.(2) The untoward effect rates of two groups were:6.12%, 6.25% respectively after a year treatment. The uric acid level of group B decreased significantly, while no significant changes were observed in group A after a year treatment. There were no significant changes after the treatment in electrolyte, blood lipids, liver and kidney function and other biological items compared with prior treatment 2. Analysis of CostThe total cost of treatment of group B is 5024.2±3737.9 yuan, significantly more than group A 3291.8 which is±3990.0 yuan. After one year, the cost of treatment due to outpatient and hospitalization of group B is 4357.1±4241.4 yuan, slightly more than that of group A which is 3503.0±6365.0, but there is no significant differences between the two groups.3. Analysis of Cost-effectiveness(1) Taking effective rate as an indicator, the average cost-effectiveness ratio (C/E) of group A and B is 1984.0 and 2691.5 respectively, and the incremental cost effectiveness ratio (AC/AE) is 9621.7. The C/E of systolic and diastolic pressure of group A is 6109.8, 15813.7 respectively; while group B is 7881.0,21341.6 respectively, and the incremental cost effectiveness ratio (AC/AE) is 19014.2 72599.7,when taking reduction range of blood pressure as an indicator.(2) After a year treatment, to prevent each case of stroke, myocardial infarction, and other complications, comparing with group B, group A should add to79859.7 yuan, and to prevent each death the additional costs need 79859.7 yuan.(3) The analysis of cost-effectiveness between the two groups that accompany with coronary heart disease, diabetes, renal impairment population showed that:there were no significant differences between the two groups. The average cost-effectiveness ratio of group B is 823.8 yuan, while group A is 357.7.yuan.4. Analysis of SensitivityTaking the total effective rate as an indicator, the average cost-effectiveness ratio (C/E) of group A and B is 2679.1 and 3304.3 respectively, and the incremental cost effectiveness ratio (AC/AE) is 9428.0,if costs of drug reduced by 20% and examination and treatment expenses increased 20%. While taking reduction range of blood pressure as an indicator, the(C/E) of systolic and diastolic pressure of group A is 8250.5,21354.31 respectively; while group B is 9675.4,26200.5 respectively, and the incremental cost effectiveness ratio (AC/AE) is18631.4,71138.2.Conclusions:1. The two ways that amlodipine and amiloride, amlodipine combined with telmisartan can significantly reduce the blood pressure, and no significant differences were discovered between the two groups; two step-down programs were well tolerated with less side.2. The cost-effectiveness analysis and sensitivity analysis showed that the group added Ami Luo Li offers a better economic efficiency. |
PDF Full Text Request