Chapter 3 An Economic Assessment of Losartan-Based Versus Atenolol-Based Therapy in Patients with Hypertension and Left-Ventricular Hypertrophy : Results From the Losartan Intervention For Endpoint reduction Study Adapted to The Netherlands

Background: The Losartan Intervention For Endpoint reduction (LIFE) study was a randomized, double-blinded trial comparing effects of losartanbased treatment with those of atenolol-based treatment on cardiovascular disease (CVD)-related morbidity and mortality in 9193 patients with hypertension and left ventricular hypertrophy (LVH). Compared with atenolol, losartan reduced the combined risk of CVD-related morbidity and mortality by 13% (P = 0.021), and reduced the risk of stroke by 25% (P = 0.001), with comparable blood pressure control in both trial arms. Objective: The aim of this study was to analyze the cost-effectiveness of losartan compared with atenolol in the prevention of stroke from the Dutch health care perspective. Methods: Utilization of losartan and atenolol within the trial period (mean, 4.8 years) and an estimation of direct medical costs of stroke for the Netherlands were combined with estimates of reduction in life expectancy through stroke. Medication costs and stroke incidence during 5.5 years of patient follow-up were estimated separately, adjusted for the baseline degree of LVH and Framingham risk score. To estimate lifetime stroke costs, the cumulative incidence of stroke was multiplied by the lifetime direct medical costs attributable to stroke. All costs are in 2006 Dutch prices and discounted following the former (4% costs and effects) and new Dutch guideline (4% costs, 1.5% effects) for conducting pharmacoeconomic analyses.