1. Fixed-combination, low-dose, triple-pill antihypertensive medication versus usual care in patients with mild-to-moderate hypertension in Sri Lanka: a within-trial and modelled economic evaluation of the TRIUMPH trial
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Anthony Rodgers, Nitish Naik, Sandrine Stepien, Gotabhaya Ranasinghe, Senaka Rajapakse, Thomas Lung, Stephen Jan, Rama K Guggilla, Dorairaj Prabhakaran, Pallab K. Maulik, Vanessa Selak, Ruth Webster, Arjuna P. De Silva, Simon Thom, Tracey Lea-Laba, H Asita de Silva, Abdul Salam, Anushka Patel, Lung, Thomas, Jan, Stephen, de Silva, H Asita, Guggilla, Rama, Maulik, Pallab K, Naik, Nitish, Patel, Anushka, de Silva, Arjuna P, Rajapakse, Senaka, Ranasinghe, Gotabhaya, Prabhakaran, Dorairaj, Rodgers, Anthony, Salam, Abdul, Selak, Vanessa, Stepien, Sandrine, Thom, Simon, Webster, Ruth, Lea-Laba, Tracey, and TRIUMPH Study Group
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triple pill ,medicine.medical_specialty ,Cost-Benefit Analysis ,low-income and middle-income countries ,030231 tropical medicine ,MEDLINE ,elevated blood pressure ,03 medical and health sciences ,0302 clinical medicine ,Humans ,Medicine ,030212 general & internal medicine ,Amlodipine ,Antihypertensive Agents ,health care economics and organizations ,Sri Lanka ,Cost–benefit analysis ,business.industry ,lcsh:Public aspects of medicine ,Australia ,lcsh:RA1-1270 ,General Medicine ,3. Good health ,Blood pressure ,Pill ,Hypertension ,Economic evaluation ,Emergency medicine ,Chlorthalidone ,Telmisartan ,business ,medicine.drug - Abstract
© 2019 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license Background: Elevated blood pressure incurs a major health and economic burden, particularly in low-income and middle-income countries. The Triple Pill versus Usual Care Management for Patients with Mild-to-Moderate Hypertension (TRIUMPH) trial showed a greater reduction in blood pressure in patients using fixed-combination, low-dose, triple-pill antihypertensive therapy (consisting of amlodipine, telmisartan, and chlorthalidone) than in those receiving usual care in Sri Lanka. We aimed to assess the cost-effectiveness of the triple-pill strategy. Methods: We did a within-trial (6-month) and modelled (10-year) economic evaluation of the TRIUMPH trial, using the health system perspective. Health-care costs, reported in 2017 US dollars, were determined from trial records and published literature. A discrete-time simulation model was developed, extrapolating trial findings of reduced systolic blood pressure to 10-year health-care costs, cardiovascular disease events, and mortality. The primary outcomes were the proportion of people reaching blood pressure targets (at 6 months from baseline) and disability-adjusted life-years (DALYs) averted (at 10 years from baseline). Incremental cost-effectiveness ratios were calculated to estimate the cost per additional participant achieving target blood pressure at 6 months and cost per DALY averted over 10 years. Findings: The triple-pill strategy, compared with usual care, cost an additional US$9·63 (95% CI 5·29 to 13·97) per person in the within-trial analysis and $347·75 (285·55 to 412·54) per person in the modelled analysis. Incremental cost-effectiveness ratios were estimated at $7·93 (95% CI 6·59 to 11·84) per participant reaching blood pressure targets at 6 months and $2842·79 (−28·67 to 5714·24) per DALY averted over a 10-year period. Interpretation: Compared with usual care, the triple-pill strategy is cost-effective for patients with mild-to-moderate hypertension. Scaled up investment in the triple pill for hypertension management in Sri Lanka should be supported to address the high population burden of cardiovascular disease. Funding: Australian National Health and Medical Research Council.
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- 2019
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