Cost-effectiveness analysis of low density lipoprotein cholesterol-lowering therapy in hypertensive patients with type 2 diabetes in Korea: single-pill regimen (amlodipine/atorvastatin) versus double-pill regimen (amlodipine+atorvastatin)

Abstract

Objectives: Single-pill combination therapy (Amlodipine/Atorvastatin) may be more effective compared with a Double-pill approach (Amlodipine+Atorvastatin) in hypertensive patients requiring concomitant statin therapy. We investigated the cost-effectiveness of Single-pill compared with Double-pill for prevention of cardiovascular disease (CVD) through additional controlling LDL-C (Low Density Lipoprotein Cholesterol) level with consideration to adherence in diabetes and hypertension patients using cost-effectiveness analysis model.Methods: We determined effectiveness as percentage (%) attainment of target LDL-C levels (< 100 mg/dL) which depends on differences in patients' adherence to each alternative. 'Adherence' was defined as compliance to medication over 80% on proportional day covered (PDC) and 'non-adherence' for the remaining. The proportion of the adherent patient and target goal attainment differences in adherence level were searched through systematic review. The annual costs of medicine were included according to the adherence levels of each alternative. Average cost-effectiveness ratio (ACER) was calculated as the cost per % attainment of target LDL-C level.Results: In this study, defined Average cost-effectiveness ratio (ACER) is the cost per 1% achievement of target goal (LDL-C < 100 mg/dL), as maintaining optimal LDL-C levels is crucial for the prevention of cardiovascular disease in patients with hypertension accompanied by diabetes. ACERs in Single-pill approach were lower than those in Double-pill approach (4,123 KRW vs. 6,062 KRW per 1 % achievement of target goal). Single-pill approach reduced medication cost by around 32 % than Double-pill approach.Conclusion: Single-pill approach is cost effective compared with Double-pill approach in hypertensive patients with diabetes.