Cost-utility analysis of antihypertensive medications in Nigeria: a decision analysis

Abstract

BackgroundMany drugs are available for control of hypertension and its sequels in Nigeria but some are not affordable for majority of the populace. This serious pharmacoeconomic question has to be answered by the nation’s health economists. The objective of this study was to evaluate the cost-effectiveness of drugs from 4 classes of antihypertensive medications commonly used in Nigeria in management of hypertension without compelling indication to use a particular antihypertensive drug.MethodsThe study employed decision analytic modeling. Interventions were obtained from a meta-analysis. The Markov process model calculated clinical outcomes and costs during a life cycle of 30 years of 1000 hypertensive patients stratified by 3 cardiovascular risk groups, under the alternative intervention scenarios. Quality adjusted life year (QALY) was used to quantify clinical outcome. The average cost of treatment for the 1000 patient was tracked over the Markov cycle model of the alternative interventions and results were presented in 2010 US Dollars. Probabilistic cost-effectiveness analysis was performed using Monte Carlo simulation, and results presented as cost-effectiveness acceptability frontiers. Expected value of perfect information (EVPI) and expected value of parameter perfect information (EVPPI) analyses were also conducted for the hypothetical population.ResultsThiazide diuretic was the most cost-effective option across the 3 cardiovascular risk groups. Calcium channel blocker was the second best for Moderate risk and high risk with a willingness to pay of at least 2000$/QALY. The result was robust since it was insensitive to the parameters alteration.ConclusionsThe result of this study showed that thiazide diuretic followed by calcium channel blocker could be a feasible strategy in order to ensure that patients in Nigeria with hypertension are better controlled.

Costs and Cost-Effectiveness of Hypertension Screening and Treatment in Adults with Hypertension in Rural Nigeria in the Context of a Health Insurance Program

“…We validated acute care costs with figures from WHO-CHOICE, National Health Interview Survey (NHIS) and literature from SSA, excluding data from South Africa where the standard of care is higher compared to the rest of SSA. [ 16 , 17 , 19 , 35 , 50 – 57 ] Costs for follow-up care after CVD events were assumed to be equal to antihypertensive treatment costs with the addition of a number of drugs, depending on the event ( Table 1 , and Table J and section H, S1 File ). All prices were collected in local currency and are presented in 2012 US$ using the mean exchange rate of the study period (1 US$ = 154.4 NGN).…”

Effect of calcium channel blockers on gingival tissues in hypertensive patients in Lagos, Nigeria: A pilot study

“…[ 27 ] Moreover, the cost-effectiveness of CCB in controlling hypertension among patients in Nigeria has been highlighted and was observed to be the second best medication for moderate-to-high risk hypertension. [ 28 ] Amlodipine was the CCB drug of choice compared to nifedipine in our study and could be as a result of once-daily dosing of amlodipine compared to twice-daily dosing of nifedipine. Hence, this is likely to enhance compliance by patients.…”

Rationality of the Fixed Dose Combination of Telmisartan and Amlodipine in Management of Mild to Moderate Hypertension Unresponsive to Low Dose Monotherapy

“…The cost of a combination might be higher than one or the other drug, however, cost effectiveness is to be calculated taking into account the adverse reactions, their treatment, loss of working hours and quality of life affected. In a study conducted in Nigeria, CCB was the second most cost-effective option for medium and high risk patients in order to achieve better health outcomes after thiazide diuretic (Ekwunife et al 2013). In our study, the cost of combination was higher than that of amlodipine monotherapy, but the clinical outcome was better in terms of achieving target BP and adverse events.…”