Connect
MJA
MJA

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.

Summary

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.

Please login with your free MJA account to view this article in full

  • 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.

Correspondence: pglaszio@bond.edu.au

Acknowledgements: 

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.

  • 1. Wild S, Roglic G, Green A, et al. Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care 2004; 27: 1047-1053.
  • 2. Turnbull F, Neal B, Pfeffer M, et al. Blood pressure-dependent and independent effects of agents that inhibit the renin-angiotensin system. J Hypertens 2007; 25: 951-958.
  • 3. Gu D, Reynolds K, Wu X, et al; InterASIA Collaborative Group. Prevalence, awareness, treatment, and control of hypertension in China. Hypertension 2002; 40: 920-927.
  • 4. Ong KL, Cheung BM, Man YB, et al. Prevalence, awareness, treatment, and control of hypertension among United States adults 1999-2004. Hypertension 2007; 49: 69-75.
  • 5. Patel R, Lawlor DA, Whincup P, et al. The detection, treatment and control of high blood pressure in older British adults: cross-sectional findings from the British Women’s Heart and Health Study and the British Regional Heart Study. J Hum Hypertens 2006; 20: 733-741.
  • 6. Baker S, Priest P, Jackson R. Using thresholds based on risk of cardiovascular disease to target treatment for hypertension: modelling events averted and number treated. BMJ 2000; 320: 680-685.
  • 7. Asia Pacific Cohort Studies Collaboration, Kengne AP, Patel A, Barzi F, et al. Systolic blood pressure, diabetes and the risk of cardiovascular diseases in the Asia-Pacific region. J Hypertens 2007; 25: 1205-1213.
  • 8. Patel A, MacMahon S, Chalmers J, et al: ADVANCE Collaborative Group. Effects of a fixed combination of perindopril and indapamide on macrovascular and microvascular outcomes in patients with type 2 diabetes mellitus (the ADVANCE trial): a randomised controlled trial. Lancet 2007; 370: 829-840.
  • 9. Rationale and design of the ADVANCE study: a randomised trial of blood pressure lowering and intensive glucose control in high-risk individuals with type 2 diabetes mellitus. Action in diabetes and vascular disease: preterax and diamicron modified-release controlled evaluation. J Hypertens Suppl 2001; 19: S21-28.
  • 10. Study rationale and design of ADVANCE: action in diabetes and vascular disease — preterax and diamicron MR controlled evaluation. Diabetologia 2001; 44: 1118-1120.
  • 11. Gudex C, Kind P. The QALY toolkit. (Discussion paper 38.) York: University of York, Centre for Health Economics, 1988.
  • 12. Ware JE, Kosinski M, Dewey J. How to score version two of the SF-36 health survey. Lincoln, RI: QualityMetric Incorporated, 2000.
  • 13. Glasziou P, Alexander J, Beller E, Clarke P. Which health-related quality of life score? A comparison of alternative utility measures in patients with type 2 diabetes in the ADVANCE trial. Health Qual Life Outcomes 2007; 5: 21.
  • 14. Department of Health and Ageing. National Hospital Cost Data Collection (NHCDC) reports. 2007. Round 11 cost weights, peer group report and hospital reference manual for 2006-07. Canberra: DoHA, 2008. http://www.health.gov.au/internet/main/publishing.nsf/Content/health-casemix-data-collections-NHCDCReports (accessed Dec 2007).
  • 15. Dolan P, Roberts J. Modelling valuations for Eq-5d health states: an alternative model using differences in valuations. Med Care 2002; 40: 442-446.
  • 16. Clarke PM, Glasziou P, Patel A, et al. Event rates, hospital utilization and costs associated with major complications of diabetes: multi-country comparative analysis. PLoS Med 2010; 7: e1000236. doi: 10.1371/journal.pmed.100 0236.
  • 17. Raikou M, Gray A, Briggs A, et al; UK Prospective Diabetes Study Group. Cost effectiveness analysis of improved blood pressure control in hypertensive patients with type 2 diabetes: UKPDS 40. BMJ 1998; 317: 720-726.
  • 18. Briggs A, Mihaylova B, Sculpher M, et al; EUROPA Trial investigators. Cost effectiveness of perindopril in reducing cardiovascular events in patients with stable coronary artery disease using data from the EUROPA study. Heart 2007; 93: 1081-1086.

Author

remove_circle_outline Delete Author
add_circle_outline Add Author

Comment
Do you have any competing interests to declare? *

I/we agree to assign copyright to the Medical Journal of Australia and agree to the Conditions of publication *
I/we agree to the Terms of use of the Medical Journal of Australia *
Email me when people comment on this article

Responses are now closed for this article.