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Controlling hypertension immediately post stroke: a cost utility analysis of a pilot randomised controlled trial

DOI: 10.1186/1478-7547-8-3

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Abstract:

Economic evaluation alongside a double-blind randomised placebo-controlled trial (National Research Register Trial Number N0484128008) of 112 hypertensive patients receiving an antihypertensive regimen (labetalol or lisinopril) within 36 hours post stroke versus 59 receiving placebo. Outcomes were incremental cost per incremental: QALY, survivor, and patient free from death or severe disability (modified Rankin scale score < 4) at three months and 14 days post stroke.Actively treated patients on average had superior outcomes and lower costs than controls at three months. From the perspective of the acute hospital setting, there was a 96.5% probability that the incremental cost per QALY gained at three months is below £30,000, although the probability may be overstated due to data limitations.Antihypertensive therapy when indicated immediately post stroke may be cost-effective compared with placebo from the acute hospital perspective. Further research is required to confirm both efficacy and cost-effectiveness and establish whether benefits are maintained over a longer time horizon.Approximately 52,000 patients experience first stroke [1], and 135,000 experience first or recurrent stroke in England and Wales each year [2]. It is the third biggest cause of death and the most important single cause of severe adult disability [3]. The societal cost of stroke to England and Wales is estimated at £7bn, of which 40% are direct care costs, 35% informal care, and the remaining 25% indirect costs (lost productivity) [4].Elevated blood pressure (BP) levels are common following onset of acute stroke, and observational data suggest that both high and low BP levels are associated with poor short and long term prognosis [5-16]. The acute management of post-stroke BP changes is a matter of some debate, with considerable differences of opinion on when to initiate antihypertensive therapy [17]. A Cochrane review of BP manipulation following stroke concluded that there was insufficien

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