An economic evaluation of atenolol vs. captopril in patients with Type 2 diabetes (UKPDS 54)

Aims To compare the net cost of a tight blood pressure control policy with an angiotensin converting enzyme inhibitor (captopril) or beta blocker (ate nolol) in patients with Type 2 diabetes. Design A cost-effectiveness analysis based on outcomes and resources used i n a randomized controlled trial and assumptions regarding the use of these therapies in a general practice setting. Setting Twenty United Kingdom Prospective Diabetes Study Hospital-based cli nics in England, Scotland and Northern Ireland. Subjects Hypertensive patients (n = 758) with Type 2 diabetes (mean age 56 years, mean blood pressure 159/94 mmHg), 400 of whom were allocated to the angiotensin converting enzyme inhibitor captopril and 358 to the beta block er atenolol. Main outcome measures Life expectancy and mean cost per patient. Results There was no statistically significant difference in life expectanc y between groups. The cost per patient over the trial period was pound 6485 in the captopril group, compared with pound 5550 in the atenolol group, an average cost difference of pound 935 (95% confidence interval pound 188, p ound 1682). This 14% reduction arose partly because of lower drug prices, a nd also because of significantly fewer and shorter hospitalizations in the atenolol group, and despite higher antidiabetic drug costs in the atenolol group. Conclusions Treatment of hypertensive patients with Type 2 diabetes using a tenolol or captopril was equally effective. However, total costs were signi ficantly lower in the atenolol group.