The Cost-Effectiveness of Hypertension Pharmacotherapy in Serbia: A Markov Model

To date there is no Markov model to evaluate the cost-effectiveness of antihypertensive pharmacotherapies at national level in developing countries. The aim of our study was to evaluate different antihypertensives and determine their cost-effectiveness as monotherapy treatment in primary care in Serbia. We developed a Markov model to estimate quality-adjusted life years (QALY), lifetime costs and incremental cost-effectiveness of different antihypertensive medicines used in the clinical practice in Serbia (diuretic, beta blocker, Ca channel blocker and ACE inhibitors) to strategy "no intervention". Cohort of 55-year-old patients with hypertension (systolic and diastolic blood pressure ≥140 and 90 mmHg), without cardiovascular complications was run through the model. Acute myocardial infarction, angina pectoris, heart failure, stroke, and total mortality were observed as outcomes. The time horizon was over a lifetime, and the perspective was that of a third-party payer. Annual discount rate of 5% was applied to all future costs and effects. The results showed small differences in QALY in strategies ACE inhibitor, beta blockers, and diuretic. The incremental cost-effectiveness ratio (ICER) for diuretic, compared to no intervention, was €74.27/QALY. The ICER for beta blocker compared to diuretic was €75.58/QALY. ACE inhibitor was extended dominated by diuretic and beta blocker, while Ca channel blocker had higher costs and less effectiveness compared to all previous strategies. The results of the probabilistic sensitivity analysis showed that application of antihypertensive therapy is cost-effective even at small values of willingness to pay. It could be concluded that for individuals aged 55 the diuretics are the most cost-effective strategy to start monotherapy of hypertension.