Cost-effectiveness of lowering blood pressure with a fixed combination of perindopril and indapamide in type 2 diabetes mellitus: An ADVANCE trial-based analysis

Paul P. Glasziou*, Philip Clarke, Jan Alexander, Mohana Rajmokan, Elaine Beller, Mark Woodward, John Chalmers, Neil Poulter, Anushka Patel

*Corresponding author for this work

Research output: Contribution to journalArticleResearchpeer-review

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Objective: to determine the cost-effectiveness of routine administration, irrespective of blood pressure (BP), of a fixed-dose combination of perindopril and indapamide to patients with type 2 diabetes mellitus

Design, setting and participants: Prospective cost-effectiveness analysis within the Action in Diabetes and Vascular Disease Preterax and Diamicron-MR Controlled Evaluation (ADVANCE) trial, an international, multicentre, randomised controlled trial of 11 140 participants with type 2 diabetes randomly allocated to receive perindopril plus indapamide (4 mg-1 25 mg/day) or placebo

Main outcome measures: Health-related quality-of-life measured by the EuroQol-5D, resource utilisation, and cost-effectiveness (cost per death averted at 4 3 years' average follow-up, and estimated cost per life-year gained, by extrapolation)

Results: The mean health-related quality-of-life score of survivors was 080 (on a 0-1 scale [death to full health]), with no difference between treatment groups Active treatment reduced hospital admissions for coronary heart disease and coronary revascularisation by 5% For the Australian participants, perindopril indapamide cost A$1368 per patient during the trial period, but reduced total hospitalisation costs by A$410 and other medication costs (mainly other BP-lowering drugs) by A$332 The absolute reduction in all-cause mortality for the active treatment group was 1 1%, giving a cost per life saved of A$49200 Lifetime extrapolation gave an estimated cost per life-year saved of A$10 040 (discounted at 5% per year)

Conclusion: The combination of perindopril and indapamide in patients with type 2 diabetes appears to be cost-effective

Original languageEnglish
Pages (from-to)320-324
Number of pages6
JournalMedical Journal of Australia
Issue number6
Publication statusPublished - 20 Sep 2010


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