Which is more important for the efficiency of hypertension treatment: hypertension stage, type of drug or therapeutic compliance?

Objectives Hypertensive patients are a heterogeneous population that can be distributed in groups showing different cardiovascular risk and benefit fr om treatment, This study examines the cost-effectiveness of arterial hypert ension treatment by age, sex, arterial hypertension stage, type of drug use d and level of treatment compliance. Design Markov models combining absolute risks for stroke, coronary heart di sease and all causes of death with relative risks from clinical trials and observational studies. Data on health costs were collected from hospitals a nd primary care settings in the Basque Country (Spain), Results Cost-effectiveness ratios vary from 34 516 euros/quality adjusted l ife year (QALY) gained in 30-year-old women to 3307 euros/QALY in 80-year-o ld men. A treatment compliance of 50% increases these values to 45 270 and 4905 euros/QALY, respectively. Treatment of arterial hypertension stage II shows lower ratios (19 798 euros/QALY in 30-year-old women and 1918 euros/Q ALY in 80-year-old persons), Cost-effectiveness ratios for arterial hyperte nsion stage I vary from 645 euros/QALY in 80-year-old men for diuretics to 47 325 euros/QALY in 30- year-old women for inhibitors of the angiotensin c onverting enzyme. Conclusions There are large variations in the cost-effectiveness of arteria l hypertension treatment depending on age, sex, arterial hypertension stage , drug used and compliance. Improvement of treatment compliance yields the greatest gain both in effectiveness and efficiency, (C) 2001 Lippincott Wil liams & Wilkins.