Cost-effectiveness Analysis of Manidipine versus Amlodipine as Add-on to Renin-angiotensin System Blockers in Hypertensive Patients with Diabetes mellitus and Proteinuria
Abstract
OBJECTIVES: Diabetes and hypertension are the most common causes of chronic kidney disease. Calcium channel blockers are beneficial in blood pressure reduction while also stall kidney degeneration. The aim of this study was to compare the cost-effectiveness of manidipine to amlodipine as add-on to renin-angiotensin system blockers in hypertensive patient with diabetes mellitus and proteinuria to slow down kidney degeneration. METHODS: A lifetime Markov decision model was used to evaluate total costs and quality-adjusted life years (QALYs) using published data on clinical outcomes and Thai data on cost and humanistic outcomes. This study adopted a societal perspective. RESULTS: The results demonstrated that the total cost of the treatment with manidipine was 74,425.87 Baht compared to 461,918.70 Baht for amlodipine, and the QALYs were 9.15 and 6.84 years respectively. The cost - effectiveness ratio (CER) of manidipine was 8,132.85 Baht per QALY compared to 67,499.05 Baht per QALY for amlodipine. CONCLUSIONS: Manidipine has higher cost-effectiveness than amlodipine in the treatment of Thai hypertensive patients with diabetes mellitus and proteinuria, it was associated with better clinical outcome in terms of QALYs and lower cost than amlodipine. Manidipine should be used as a first choice as an add-on to renin-angiotensin system blockers. The results of this study could contribute to appropriate decision making by policy maker.
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