Comprehensive overview: efficacy, tolerability, and cost-effectiveness of irbesartan

Gialama, Fotini; Maniadakis, Nikos

doi:10.2147/vhrm.s50831

Cited by 6 publications

(7 citation statements)

References 91 publications

(120 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, this comes at an incremental cost that ranges between SAR 53.12 (USD 14.16) and SAR 144.96 (USD 38.66) per 1 mmHg reduction in SBP or DBP. These findings are consistent with the previously published studies which found that ACEIs/ARBs, such as lisinopril and irbesartan, were more cost-effective than amlodipine in the management of essential HTN [ 14 , 17 ]. These incremental benefits were more evident when ACEIs/ARBs, such as valsartan, were compared to amlodipine among patients with type 2 diabetes and microalbuminuria [ 25 ].…”

Section: Discussionsupporting

confidence: 93%

“…Although several studies have compared the efficacy and cost effectiveness of different ACEIs/ARBs and amlodipine in the management of essential HTN, the findings of these studies should be carefully interpreted due to the substantial variability of the patient characteristics and the acquisition costs of antihypertensive drugs. Moreover, these studies were not conducted among Middle Eastern or Saudi patient populations [ 13 , 14 , 16 , 17 , 18 , 19 ]. Therefore, examining the impact of ACEIs/ARBs and amlodipine on SBP and DBP when used as a monotherapy among patients with essential HTN in Saudi Arabia would be very informative to health practitioners and policy makers.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, diuretics and β-blockers were found to be more cost-effective in the management of HTN than ACEIs or CCBs based on the results of an observational population-based study in Brazil [ 16 ]. Intraclass differences among ARBs were reported on the basis of a comprehensive literature review that reviewed the safety, efficacy, and cost of irbesartan in the management of essential HTN; irbesartan was found to be the most preferred antihypertensive agent in comparison to other ARBs as well as other antihypertensive alternatives [ 17 ]. Nonetheless, amlodipine was associated with lower cost and better efficacy in preventing stroke and myocardial infarction in comparison to ARBs according to two Markov-based analyses [ 18 , 19 ].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Cost Effectiveness of ACEIs/ARBs versus Amlodipine Monotherapies: A Single-Center Retrospective Chart Review

et al. 2021

View full text Add to dashboard Cite

The aim of this retrospective chart review study was to examine the cost effectiveness of angiotensin-converting enzyme inhibitors (ACEIs); angiotensin receptor blockers (ARBs); and dihydropyridine calcium channel blockers (CCBs) such as amlodipine, monotherapies in the management of essential hypertension among adult patients (≥18 years) without cancer, cardiovascular disease, and chronic kidney disease in the primary care clinics of a university-affiliated tertiary care hospital. Patients were followed up for at least 12 months from the initiation of therapy. Propensity score bin bootstrapping with 10,000 replications was conducted to generate the 95% confidence intervals (CI) for both treatment outcome (e.g., reduction of the systolic (SBP) and diastolic blood pressures (DBP) in mmHG) and the cost (e.g., costs of drugs, clinic visits, and labs in Saudi riyals (SAR)). Among the 153 included patients who met the inclusion criteria, 111 patients were on ACEIs/ARBs, while 44 patients were on amlodipine. On the basis of the bootstrap distribution, we found that the use of ACEIs/ARBs was associated with an incremental reduction of SBP of up to 4.46 mmHg but with an incremental cost of up to SAR 116.39 (USD 31.04), which results in an incremental cost effectiveness ratio (ICER) of SAR 26.09 (USD 6.95) per 1 mmHg reduction with 55.26% level of confidence. With regard to DBP, ACEIs/ARBs were associated with an incremental reduction of DBP of up to 5.35 mmHg and an incremental cost of up to SAR 144.96 (USD 38.66), which results in an ICER of SAR 27.09 (USD 7.23) per 1 mmHg reduction with 68.10% level of confidence. However, ACEIs/ARBs were less effective and costlier than amlodipine in reducing SBP and DBP with 44.74% and 31.89% levels of confidence, respectively. The findings of this study indicate that the use of ACEI or ARB as a monotherapy seems to be more effective than amlodipine monotherapy in the management of essential hypertension in primary care settings with minimal incremental cost.

show abstract

Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Cost Effectiveness of ACEIs/ARBs versus Amlodipine Monotherapies: A Single-Center Retrospective Chart Review

et al. 2021

View full text Add to dashboard Cite

show abstract

“…Many pharmacoeconomic studies of antihypertensive medicines conducted in recent years have found control of hypertension to be cost effective. Several systematic reviews of these studies also have been published, but their focus has been on a specific medicine, such as irbesartan, 11 or medicine class, such as ACEIs or ARBs. 12 Thus, no comprehensive review has been conducted for studies across all anti-hypertensive medicine classes.…”

Section: Contextmentioning

confidence: 99%

Cost-effectiveness Analyses of Antihypertensive Medicines: A Systematic Review

Park

Wang

Durthaler

et al. 2017

American Journal of Preventive Medicine

View full text Add to dashboard Cite

ContextHypertension affects one third of the U.S. adult population. Although cost-effectiveness analyses of antihypertensive medicines have been published, a comprehensive systematic review across medicine classes is not available.Evidence acquisitionPubMed, Embase, Cochrane Library, and Health Technology Assessment were searched to identify original cost-effectiveness analyses published from 1990 through August 2016. Results were summarized by medicine class: angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), calcium channel blockers (CCBs), thiazide-type diuretics, β-blockers, and others. Incremental cost-effectiveness ratios (ICERs) were adjusted to 2015 U.S. dollars.Evidence synthesisAmong 76 studies reviewed, 14 compared medicines with no treatment, 16 compared medicines with conventional therapy, 29 compared between medicine classes, 13 compared within medicine class, and 11 compared combination therapies. All antihypertensives were cost effective compared with no treatment (ICER/quality-adjusted life year [QALY]=dominant–$19,945). ARBs were more cost effective than CCBs (ICER/QALY=dominant–$13,016) in nine comparisons, whereas CCBs were more cost effective than ARBs (ICER/QALY=dominant) in two comparisons. ARBs were more cost effective than ACEIs (ICER/QALY=dominant–$34,244) and β-blockers (ICER/QALY=$1,498–$18,137) in all eight comparisons.ConclusionsAll antihypertensives were cost effective compared with no treatment. ARBs appeared to be more cost effective than CCBs, ACEIs, and β-blockers. However, these latter findings should be interpreted with caution because these findings are not robust due to the substantial variability across the studies, including study settings and analytic models, changes in the cost of generic medicines, and publication bias.

show abstract

“…Unlike other studies, AIMS assessed the effects of irbesartan in Marfan syndrome. Irbesartan is a selective angiotensin type-1 receptor blocker with greater bioavailability and a longer half-life than losartan (11–15 h for irbesartan vs 6–9 h for losartan), with more powerful antihypertensive effects 25, 26. Irbesartan might also have effects on the pathophysiology of aortic disease, including TGF-β pathways 7 .…”

Section: Discussionmentioning

confidence: 99%

Irbesartan in Marfan syndrome (AIMS): a double-blind, placebo-controlled randomised trial

et al. 2019

View full text Add to dashboard Cite

SummaryBackgroundIrbesartan, a long acting selective angiotensin-1 receptor inhibitor, in Marfan syndrome might reduce aortic dilatation, which is associated with dissection and rupture. We aimed to determine the effects of irbesartan on the rate of aortic dilatation in children and adults with Marfan syndrome.MethodsWe did a placebo-controlled, double-blind randomised trial at 22 centres in the UK. Individuals aged 6–40 years with clinically confirmed Marfan syndrome were eligible for inclusion. Study participants were all given 75 mg open label irbesartan once daily, then randomly assigned to 150 mg of irbesartan (increased to 300 mg as tolerated) or matching placebo. Aortic diameter was measured by echocardiography at baseline and then annually. All images were analysed by a core laboratory blinded to treatment allocation. The primary endpoint was the rate of aortic root dilatation. This trial is registered with ISRCTN, number ISRCTN90011794.FindingsBetween March 14, 2012, and May 1, 2015, 192 participants were recruited and randomly assigned to irbesartan (n=104) or placebo (n=88), and all were followed for up to 5 years. Median age at recruitment was 18 years (IQR 12–28), 99 (52%) were female, mean blood pressure was 110/65 mm Hg (SDs 16 and 12), and 108 (56%) were taking β blockers. Mean baseline aortic root diameter was 34·4 mm in the irbesartan group (SD 5·8) and placebo group (5·5). The mean rate of aortic root dilatation was 0·53 mm per year (95% CI 0·39 to 0·67) in the irbesartan group compared with 0·74 mm per year (0·60 to 0·89) in the placebo group, with a difference in means of −0·22 mm per year (−0·41 to −0·02, p=0·030). The rate of change in aortic Z score was also reduced by irbesartan (difference in means −0·10 per year, 95% CI −0·19 to −0·01, p=0·035). Irbesartan was well tolerated with no observed differences in rates of serious adverse events.InterpretationIrbesartan is associated with a reduction in the rate of aortic dilatation in children and young adults with Marfan syndrome and could reduce the incidence of aortic complications.FundingBritish Heart Foundation, the UK Marfan Trust, the UK Marfan Association.

show abstract

Comprehensive overview: efficacy, tolerability, and cost-effectiveness of irbesartan

Cited by 6 publications

References 91 publications

Cost Effectiveness of ACEIs/ARBs versus Amlodipine Monotherapies: A Single-Center Retrospective Chart Review

Cost Effectiveness of ACEIs/ARBs versus Amlodipine Monotherapies: A Single-Center Retrospective Chart Review

Cost-effectiveness Analyses of Antihypertensive Medicines: A Systematic Review

Irbesartan in Marfan syndrome (AIMS): a double-blind, placebo-controlled randomised trial

Contact Info

Product

Resources

About