ABSTRACT
Background: Efficient use of the combinations recommended by Joint National Committee (JNC7) guideline can improve cost of achieving goal blood pressure in our environment.
Objective: The objective of this study was to evaluate the cost effectiveness of model 1 (2 antihypertensive drug combinations) and model 2 (more than 2 antihypertensive drug combinations) for effective control of blood pressure in Nigerian hypertensive patients.
Method: Retrospective data and analytical model were used to determine the cost effectiveness of the two treatment model for the control of blood pressure from the patient’s perspective. Hypertensive patients were categorized into stage 1, stage 2 and sample population as a whole. Data extracted from the patients folders were used to estimate the cost and extent of blood pressure control achieved by the two treatment models and was used to calculate the average cost effectiveness ratio (ACER). A Monte Carlo’s simulation which simulated 1000 iterations was used to calculate mean incremental cost effectiveness ratio (ICER), a probabilistic cost effectiveness which was presented on cost effectiveness acceptability curve (CEAC) and Net monetary benefit. Data was analyzed using SPSS version 16 and Microsoft excel.
Results: In a sample of 201 patients that had 500 encounters, percentage use of model 1 compared to model 2 was 59% vs 41%. (ACER) of model 1 treatment compared to model 2 treatment was (₦839 vs ₦2471), (₦1407 vs ₦4415), (₦919 vs ₦3244) for stage 1, stage 2 and the sample population as a whole. Mean ICER of model 1 over model 2 was ₦-3295, ₦-10935.2, ₦-2836.2 for stage 1, stage 2 and sample population as a whole. Probabilistic cost effectiveness of model 1 treatment was higher than model 2 treatment over most of the willingness to pay value. Average net monetary benefit of model 1 compared to model 2 was ₦2837 vs ₦1237, ₦1171 vs ₦154, ₦2400 vs ₦639 for stage 1, stage 2 and all patients respectively. Conclusion: The study provides evidence that 2 antihypertensive drug combinations is more cost effective than more than 2 antihypertensive drug combinations in achieving target blood pressure for all stages of hypertension in Nigeria.
