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Cost-effectiveness of lowering blood pressure with a fixed combination of perindopril and indapamide in type 2 diabetes mellitus: An ADVANCE trial-based analysis

Paul Glasziou, Bond University
Philip M. Clarke, University of Sydney
Jan Alexander, University of Queensland
Mohana Rajmokan, Queensland Health
Elaine Beller, University of Queensland
Mark Woodward, University of Sydney; The George Institute for International Health
John Chalmers, University of Sydney; The George Institute for International Health
Neil Poulter, Imperial College London
Anushka A. Patel, The George Institute for International Health

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Published Version.

Glasziou, P.P., Clarke, P., Alexander, J., Rajmokan, M., Beller, E., Woodward, M., Chalmers, J., Poulter, N., & Patel, A. (2010). Cost-effectiveness of lowering blood pressure with a fixed combination of perindopril and indapamide in type 2 diabetes mellitus: An ADVANCE trial-based analysis. Medical Journal of Australia (MJA), 193(6), 320-324.

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© Copyright Australasian Medical Publishing Company, 2010

Abstract

Objective: To determine the cost-effectiveness of routine administration, irrespective of blood pressure (BP), of a fixed-dose combination of perindopril and indapamide to patients with type 2 diabetes mellitus.

Design, setting and participants: Prospective cost-effectiveness analysis within the Action in Diabetes and Vascular Disease: Preterax and Diamicron-MR Controlled Evaluation (ADVANCE) trial, an international, multicentre, randomised controlled trial of 11 140 participants with type 2 diabetes randomly allocated to receive perindopril plus indapamide (4mg-1.25mg/day) or placebo.

Main outcome measures: Health-related quality-of-life measured by the EuroQol-5D, resource utilisation, and cost-effectiveness (cost per death averted at 4.3 years' average follow-up, and estimated cost per life-year gained, by extrapolation).

Results: The mean health-related quality-of-life score of survivors was 0.80 (on a 0-1 scale [death to full health]), with no difference between treatment groups. Active treatment reduced hospital admissions for coronary heart disease and coronary revascularisation by 5%. For the Australian participants, perindopril-indapamide cost A$1368 per patient during the trial period, but reduced total hospitalisation costs by A$410 and other medication costs (mainly other BP-lowering drugs) by A$332. The absolute reduction in all-cause mortality for the active treatment group was 1.1%, giving a cost per life saved of A$49 200. Lifetime extrapolation gave an estimated cost per life-year saved of A$10 040 (discounted at 5% per year).

Conclusion: The combination of perindopril and indapamide in patients with type 2 diabetes appears to be cost-effective.

Trial registration: United States National Library of Medicine NCT00145925.

Suggested Citation

Paul Glasziou, Philip M. Clarke, Jan Alexander, Mohana Rajmokan, Elaine Beller, Mark Woodward, John Chalmers, Neil Poulter, and Anushka A. Patel. "Cost-effectiveness of lowering blood pressure with a fixed combination of perindopril and indapamide in type 2 diabetes mellitus: An ADVANCE trial-based analysis" The Medical Journal of Australia (MJA) 193.6 (2010): 320-324.
Available at: http://works.bepress.com/paul_glasziou/18