Choice of generic antihypertensive drugs for the primary prevention of cardiovascular disease - A cost-effectiveness analysis

We used the Norwegian Cardiovascular Disease model (NorCaD) to simulate the cardiovascular life of patients from hypertension without symptoms until they were all dead or 100 years old. The risk of CVD events and costs were based on recent Norwegian sources.In single-drug treatment, all antihypertensives are cost-effective compared to no drug treatment. In the base-case analysis, the first, second and third choice of antihypertensive were calcium channel blocker, thiazide and angiotensin-converting enzyme inhibitor. However the sensitivity and scenario analyses indicated considerable uncertainty in that angiotensin receptor blockers as well as, angiotensin-converting enzyme inhibitors, beta blockers and thiazides could be the most cost-effective antihypertensive drugs.Generic antihypertensives are cost-effective in a wide range of risk groups. There is considerable uncertainty, however, regarding which drug is the most cost-effective.Hypertension is a major risk factor for cardiovascular disease (CVD) such as acute myocardial infarction (AMI), stroke, heart failure and death. WHO has estimated that hypertension alone accounts for 4.4% of all disability adjusted life years that are lost [1]. An array of randomized controlled trials (RCTs) has demonstrated that antihypertensive drugs can reduce the risk of CVD. This is the case for thiazides, beta blockers, calcium channel blockers (CCB), angiotensin receptor blockers (ARB) and angiotensin-converting-enzyme inhibitors (ACE) [2]. Still, there is uncertainty and even controversy related to the intervention thresholds and the choice of first-line drug and "add-on" drugs. The controversy is partly related to the price of the different drugs, and partly to disagreements about how the available evidence on effectiveness, and side-effects of the various drugs should be interpreted [3,4].The prices of the different antihypertensives vary, and price alone is only one factor which should be taken into account when considering w