Costs of Eprosartan versus Diuretics for Treatment of Hypertension in a Geriatric Population An Observational, Open-Label, Multicentre Study

• Published in: Drugs & aging Vol. 26; no. 7; pp. 617 - 626
• Main Authors: Alvarez Gregori, Joaquin A., Macías Nuñez, Juan F., Domínguez-Gil, Alfonso
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.01.2009; Adis International; Wolters Kluwer Health, Inc; Springer Nature B.V
• Subjects: Acrylates - adverse effects; Acrylates - economics; Acrylates - pharmacology; Acrylates - therapeutic use; Aged; Analysis; Angiotensin II Type 1 Receptor Blockers - adverse effects; Angiotensin II Type 1 Receptor Blockers - economics; Angiotensin II Type 1 Receptor Blockers - pharmacology; Angiotensin II Type 1 Receptor Blockers - therapeutic use; Arterial hypertension. Arterial hypotension; Biological and medical sciences; Blood and lymphatic vessels; Blood Pressure - drug effects; Cardiology. Vascular system; Costs and Cost Analysis; Diuretics; Diuretics - adverse effects; Diuretics - economics; Diuretics - pharmacology; Diuretics - therapeutic use; Drug therapy; Female; Geriatrics - economics; Geriatrics/Gerontology; Health aspects; Humans; Hypertension; Hypertension - drug therapy; Hypertension - economics; Hypertension - epidemiology; Hypertension - physiopathology; Imidazoles - adverse effects; Imidazoles - economics; Imidazoles - pharmacology; Imidazoles - therapeutic use; Internal Medicine; Male; Medical care, Cost of; Medical sciences; Medicine; Medicine & Public Health; Original Research Article; Pharmacology. Drug treatments; Pharmacology/Toxicology; Pharmacotherapy; Thiophenes - adverse effects; Thiophenes - economics; Thiophenes - pharmacology; Thiophenes - therapeutic use; Spain; Chronic Obstructive Pulmonary Disease; Diastolic Blood Pressure; Urinary Incontinence; Acquisition Cost; Mitral Valve Stenosis; Imidazole derivatives; Costs; Multicenter study; Peptide hormone; Non peptide compound; Cardiovascular disease; Review; Diuretic; Thiophene derivatives; Octapeptide; Eprosartan; Angiotensin II; Public health; Human; Hypertension; Renin angiotensin system; Treatment; Health economy; Antihypertensive agent; Sartan derivatives; Angiotensin antagonist; Economic aspect; Elderly; Comparative study; Geriatrics
• ISSN: 1170-229X; 1179-1969
• DOI: 10.2165/11316370-000000000-00000

Background Diuretics are considered to be agents of first choice when treating hypertension in the elderly because of their clinical efficacy and, in particular, their low cost. Indeed, the latter consideration has been used by health resource managers to promote the use of diuretics. However, when considering the costs of treating hypertension in a population it is also necessary to assess the adverse effects that diuretics produce, particularly in elderly people. Objective To compare the overall expenditure associated with the treatment of hypertension (specifically the angiotensin II type 1 receptor antagonist eprosartan vs diuretics) in an elderly population, taking into consideration not only the drug acquisition costs but also the adverse effects of treatment and the costs associated with such adverse effects. Methods This was a prospective, observational, nonrandomized, open-label, multicentre study based in eight community health centres and the Hypertension Unit of the University Hospital of Salamanca, Spain. The study included 220 hypertensive geriatric outpatients (males and females aged ≥65 years) referred from general practitioners and the Hypertension Unit, with a mean age of 71.8 years and distributed into two groups: one (n = 90) treated with diuretics and the other (n= 130) treated with eprosartan. Following an initial clinical assessment of patients at the beginning of the study, monitoring of treatment continued for 1 year with follow-up consultations scheduled for 3, 6 and 12 months. Both the costs relating to acquisition of the drugs and the costs derived from secondary adverse effects of drug treatment were included in the analysis. Results The response to the antihypertensive therapy was similar in both groups. In patients taking diuretics, adverse events resulted in increased use of healthcare resources because of urinary incontinence, purchase of adsorbents, hyponatraemia and the need to admit two patients to hospital. The patient/day cost was €1.05 for the group treated with diuretics and €0.98 for the group treated with eprosartan (year of costing 2006). Conclusion In the geriatric population, the acquisition cost of the prescribed diuretics is not representative of the actual antihypertensive treatment expenditure. According to the results obtained in our study, the overall costs of eprosartan therapy were no different to those of diuretics, despite the fact that eprosartan had a higher acquisition cost. This is consistent with a more favourable safety profile for eprosartan, which may possibly contribute to improved prescription compliance. This conclusion should be taken into consideration when evaluating economic restrictions on the use of drugs.