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 P Glasziou, Philip M Clarke, Jan Alexander, Mohana Rajmokan, Elaine Beller, Mark Woodward, John Chalmers, Neil Poulter and Anushka A Patel
Med J Aust 2010; 193 (6): 320-324.


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 (4 mg–1.25 mg/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.

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  • Paul P Glasziou1
  • Philip M Clarke2
  • Jan Alexander3
  • Mohana Rajmokan4
  • Elaine Beller3
  • Mark Woodward2,5
  • John Chalmers2,5
  • Neil Poulter6
  • Anushka A Patel5

  • 1 Clinical Epidemiology and Biostatistics, Bond University, Gold Coast, QLD.
  • 2 University of Sydney, Sydney, NSW.
  • 3 Queensland Clinical Trials Centre, University of Queensland, Brisbane, QLD.
  • 4 Centre for Healthcare Related Infection Surveillance and Prevention, Queensland Health, Brisbane, QLD.
  • 5 The George Institute for International Health, Sydney, NSW.
  • 6 Imperial College London, London, UK.



We thank Peter Walker and 3M Australia for granting us use of their software for our analyses, the ADVANCE centres, and the ADVANCE trial patients. The ADVANCE trial is funded by grants from the National Health and Medical Research Council of Australia and Institut de Recherches Internationales Servier. Members of the ADVANCE Collaborative Group are fully listed in The Lancet.9 Neil Poulter received funding from the UK National Institute for Health Research Biomedical Research Centre funding scheme. The George Institute provided institutional grants for work on the substudy by Paul Glasziou, Philip Clarke, Janet Alexander, Mohana Rajmokan, and Elaine Beller. John Chalmers and Philip Clarke received institutional research grants from Servier.

Competing interests:

Paul Glasziou was reimbursed by the George Institute for travel to management committee meetings. John Chalmers is paid as a Board Member of the Servier International Diabetes Advisory Board. John Chalmers, Anushka Patel, Neil Poulter and Mark Woodward have received honoraria from Servier for speaking at scientific meetings. Mark Woodward has been paid by Roche as a member of the dal-PLAQUE steering committee and as a consultant by Servier, AstraZeneca and GlaxoSmithKline.

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