An economic evaluation of atenolol vs. captopril in patients with Type 2 diabetes (UKPDS 54)
Aims To compare the net cost of a tight blood pressure control policy with an angiotensin converting enzyme inhibitor (captopril) or β blocker (atenolol) in patients with Type 2 diabetes. Design A cost‐effectiveness analysis based on outcomes and resources used in a randomized controlled trial a...
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| Published in | Diabetic medicine Vol. 18; no. 6; pp. 438 - 444 |
|---|---|
| Main Authors | , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
Oxford, UK
Blackwell Science Ltd
01.06.2001
Blackwell |
| Subjects | |
| Online Access | Get full text |
| ISSN | 0742-3071 1464-5491 |
| DOI | 10.1046/j.1464-5491.2001.00485.x |
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| Abstract | Aims
To compare the net cost of a tight blood pressure control policy with an angiotensin converting enzyme inhibitor (captopril) or β blocker (atenolol) in patients with Type 2 diabetes.
Design
A cost‐effectiveness analysis based on outcomes and resources used in a randomized controlled trial and assumptions regarding the use of these therapies in a general practice setting.
Setting
Twenty United Kingdom Prospective Diabetes Study Hospital‐based clinics in England, Scotland and Northern Ireland.
Subjects
Hypertensive patients (n= 758) with Type 2 diabetes (mean age 56 years, mean blood pressure 159/94 mmHg), 400 of whom were allocated to the angiotensin converting enzyme inhibitor captopril and 358 to the β blocker atenolol.
Main outcome measures Life expectancy and mean cost per patient.
Results There was no statistically significant difference in life expectancy between groups. The cost per patient over the trial period was £6485 in the captopril group, compared with £5550 in the atenolol group, an average cost difference of £935 (95% confidence interval £188, £1682). This 14% reduction arose partly because of lower drug prices, and also because of significantly fewer and shorter hospitalizations in the atenolol group, and despite higher antidiabetic drug costs in the atenolol group.
Conclusions Treatment of hypertensive patients with Type 2 diabetes using atenolol or captopril was equally effective. However, total costs were significantly lower in the atenolol group.
Diabet. Med. 18, 438–444 (2001) |
|---|---|
| AbstractList | To compare the net cost of a tight blood pressure control policy with an angiotensin converting enzyme inhibitor (captopril) or beta blocker (atenolol) in patients with Type 2 diabetes.AIMSTo compare the net cost of a tight blood pressure control policy with an angiotensin converting enzyme inhibitor (captopril) or beta blocker (atenolol) in patients with Type 2 diabetes.A cost-effectiveness analysis based on outcomes and resources used in a randomized controlled trial and assumptions regarding the use of these therapies in a general practice setting.DESIGNA cost-effectiveness analysis based on outcomes and resources used in a randomized controlled trial and assumptions regarding the use of these therapies in a general practice setting.Twenty United Kingdom Prospective Diabetes Study Hospital-based clinics in England, Scotland and Northern Ireland.SETTINGTwenty United Kingdom Prospective Diabetes Study Hospital-based clinics in England, Scotland and Northern Ireland.Hypertensive patients (n = 758) with Type 2 diabetes (mean age 56 years, mean blood pressure 159/94 mmHg), 400 of whom were allocated to the angiotensin converting enzyme inhibitor captopril and 358 to the beta blocker atenolol.SUBJECTSHypertensive patients (n = 758) with Type 2 diabetes (mean age 56 years, mean blood pressure 159/94 mmHg), 400 of whom were allocated to the angiotensin converting enzyme inhibitor captopril and 358 to the beta blocker atenolol.Life expectancy and mean cost per patient.MAIN OUTCOME MEASURESLife expectancy and mean cost per patient.There was no statistically significant difference in life expectancy between groups. The cost per patient over the trial period was 6485 UK pounds in the captopril group, compared with 5550 UK pounds in the atenolol group, an average cost difference of 935 UK pounds (95% confidence interval 188 UK pounds, 1682 UK pounds). This 14% reduction arose partly because of lower drug prices, and also because of significantly fewer and shorter hospitalizations in the atenolol group, and despite higher antidiabetic drug costs in the atenolol group.RESULTSThere was no statistically significant difference in life expectancy between groups. The cost per patient over the trial period was 6485 UK pounds in the captopril group, compared with 5550 UK pounds in the atenolol group, an average cost difference of 935 UK pounds (95% confidence interval 188 UK pounds, 1682 UK pounds). This 14% reduction arose partly because of lower drug prices, and also because of significantly fewer and shorter hospitalizations in the atenolol group, and despite higher antidiabetic drug costs in the atenolol group.Treatment of hypertensive patients with Type 2 diabetes using atenolol or captopril was equally effective. However, total costs were significantly lower in the atenolol group. Diabet. Med. 18, 438-444 (2001)CONCLUSIONSTreatment of hypertensive patients with Type 2 diabetes using atenolol or captopril was equally effective. However, total costs were significantly lower in the atenolol group. Diabet. Med. 18, 438-444 (2001) Aims To compare the net cost of a tight blood pressure control policy with an angiotensin converting enzyme inhibitor (captopril) or β blocker (atenolol) in patients with Type 2 diabetes. Design A cost‐effectiveness analysis based on outcomes and resources used in a randomized controlled trial and assumptions regarding the use of these therapies in a general practice setting. Setting Twenty United Kingdom Prospective Diabetes Study Hospital‐based clinics in England, Scotland and Northern Ireland. Subjects Hypertensive patients (n= 758) with Type 2 diabetes (mean age 56 years, mean blood pressure 159/94 mmHg), 400 of whom were allocated to the angiotensin converting enzyme inhibitor captopril and 358 to the β blocker atenolol. Main outcome measures Life expectancy and mean cost per patient. Results There was no statistically significant difference in life expectancy between groups. The cost per patient over the trial period was £6485 in the captopril group, compared with £5550 in the atenolol group, an average cost difference of £935 (95% confidence interval £188, £1682). This 14% reduction arose partly because of lower drug prices, and also because of significantly fewer and shorter hospitalizations in the atenolol group, and despite higher antidiabetic drug costs in the atenolol group. Conclusions Treatment of hypertensive patients with Type 2 diabetes using atenolol or captopril was equally effective. However, total costs were significantly lower in the atenolol group. Diabet. Med. 18, 438–444 (2001) Aims To compare the net cost of a tight blood pressure control policy with an angiotensin converting enzyme inhibitor (captopril) or β blocker (atenolol) in patients with Type 2 diabetes. Design A cost‐effectiveness analysis based on outcomes and resources used in a randomized controlled trial and assumptions regarding the use of these therapies in a general practice setting. Setting Twenty United Kingdom Prospective Diabetes Study Hospital‐based clinics in England, Scotland and Northern Ireland. Subjects Hypertensive patients ( n = 758) with Type 2 diabetes (mean age 56 years, mean blood pressure 159/94 mmHg), 400 of whom were allocated to the angiotensin converting enzyme inhibitor captopril and 358 to the β blocker atenolol. Main outcome measures Life expectancy and mean cost per patient. Results There was no statistically significant difference in life expectancy between groups. The cost per patient over the trial period was £6485 in the captopril group, compared with £5550 in the atenolol group, an average cost difference of £935 (95% confidence interval £188, £1682). This 14% reduction arose partly because of lower drug prices, and also because of significantly fewer and shorter hospitalizations in the atenolol group, and despite higher antidiabetic drug costs in the atenolol group. Conclusions Treatment of hypertensive patients with Type 2 diabetes using atenolol or captopril was equally effective. However, total costs were significantly lower in the atenolol group. Diabet. Med. 18, 438–444 (2001) To compare the net cost of a tight blood pressure control policy with an angiotensin converting enzyme inhibitor (captopril) or beta blocker (atenolol) in patients with Type 2 diabetes. A cost-effectiveness analysis based on outcomes and resources used in a randomized controlled trial and assumptions regarding the use of these therapies in a general practice setting. Twenty United Kingdom Prospective Diabetes Study Hospital-based clinics in England, Scotland and Northern Ireland. Hypertensive patients (n = 758) with Type 2 diabetes (mean age 56 years, mean blood pressure 159/94 mmHg), 400 of whom were allocated to the angiotensin converting enzyme inhibitor captopril and 358 to the beta blocker atenolol. Life expectancy and mean cost per patient. There was no statistically significant difference in life expectancy between groups. The cost per patient over the trial period was 6485 UK pounds in the captopril group, compared with 5550 UK pounds in the atenolol group, an average cost difference of 935 UK pounds (95% confidence interval 188 UK pounds, 1682 UK pounds). This 14% reduction arose partly because of lower drug prices, and also because of significantly fewer and shorter hospitalizations in the atenolol group, and despite higher antidiabetic drug costs in the atenolol group. Treatment of hypertensive patients with Type 2 diabetes using atenolol or captopril was equally effective. However, total costs were significantly lower in the atenolol group. Diabet. Med. 18, 438-444 (2001) |
| Author | Stevens, R. Raikou, M. Holman, R. Cull, C. Gray, A. Stratton, I. Clarke, P. Adler, A. Neil, A. |
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| Cites_doi | 10.2337/diacare.22.7.1125 10.1016/s0140-6736(99)10327-1 10.1016/s0140-6736(99)12323-7 10.1007/s001250051617 10.1093/oso/9780195108248.001.0001 10.1007/BF00400195 10.1136/bmj.317.7160.713 10.1016/0735-1097(94)00552-2 10.1136/bmj.317.7160.703 10.1136/bmj.317.7160.720 10.1056/NEJM199808063390606 10.1001/jama.1996.03540170053032 10.1201/9781439821862 |
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| Keywords | Endocrinopathy Human Hypertension Captopril Cardiovascular disease Atenolol Non insulin dependent diabetes Chemotherapy Treatment Antihypertensive agent Blood pressure Comparative study Cost efficiency analysis |
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| Notes | ArticleID:DME485 ark:/67375/WNG-18KHPP4W-1 istex:12BE44087531429C40FAF1FFE99FBEF19141DEDE The UK Prospective Diabetes Study (UKPDS) Group: Radcliffe Infirmary, Oxford; Royal Infirmary, Aberdeen; General Hospital, Birmingham; St George's Hospital and Hammersmith Hospital, London; City Hospital, Belfast; North Staffordshire Royal Infirmary, Stoke‐on‐Trent; Royal Victoria Hospital, Belfast; St Helier Hospital, Carshalton; Whittington Hospital, London; Norfolk & Norwich Hospital; Lister Hospital, Stevenage; Ipswich Hospital; Ninewells Hospital, Dundee; Northampton Hospital, UK. ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-1 content type line 23 ObjectType-Undefined-3 |
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| References | ADA. American Diabetes Association: clinical practice recommendations 2000. Diabetes Care 2000; 23: S1 - 114. Wright JC & Weinstein MC. Gains in life expectancy from medical interventions-standardizing data on outcomes. N Engl J Med 1998; 339: 380 - 386. Heart Outcomes Prevention Evaluation Study Investigators. Effects of ramipril on cardiovascular and microvascular outcomes in people with diabetes mellitus: results of the HOPE study and MICRO-HOPE susbstudy. Lancet 2000; 355: 253 - 258.DOI: 10.1016/s0140-6736(99)12323-7 Maritz FJ, Weich HF, Schoeman HS. A comparison of the metabolic effects of captopril and atenolol on glucose, insulin and lipoproteins in patients with mild-to-moderate essential hypertension. S Afr Med J 1995; 85: 1342 - 1345. UKPDS Group. UK Prospective Diabetes Study VIII: study design, progress and performance. Diabetologia 1991; 34: 877 - 890. UKPDS Group. Efficacy of atenolol and captopril in reducing risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 39. UK Prospective Diabetes Study Group. BMJ 1998; 317: 713 - 720. Viskin S, Kitzis I, Lev E, Zak Z, Heller K, Villa Y et al. Treatment with beta-adrenergic blocking agents after myocardial infarction: from randomized trials to clinical practice. J Am Coll Cardiol 1995; 25: 1327 - 1332.DOI: 10.1016/0735-1097(94)00552-2 UKPDS Group. Cost effectiveness analysis of improved blood pressure control in hypertensive patients with type 2 diabetes: UKPDS 40. UK Prospective Diabetes Study Group. BMJ 1998; 317: 720 - 726. Hansson L, Lindholm LH, Ekbom T, Dahlof B, Lanke J, Schersten B et al. Randomised trial of old and new antihypertensive drugs in elderly patients: cardiovascular mortality and morbidity the Swedish Trial in Old Patients with Hypertension-2 study. Lancet 1999; 354: 1751 - 1756.DOI: 10.1016/s0140-6736(99)10327-1 DCCT. Lifetime benefits and costs of intensive therapy as practiced in the diabetes control and complications trial. The Diabetes Control and Complications Trial Research Group. JAMA 1996; 276: 1409 - 1415. UKPDS Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. UK Prospective Diabetes Study Group. BMJ 1998; 317: 703 - 713. Schafer JL. Analysis of Incomplete Multivariate Data. London: Chapman & Hall, 1997. Gold MR, Siegel JE, Russell LB, Weinstein MC. Cost-Effectiveness in Health and Medicine. New York: Oxford University Press, 1996. UKPDS. Quality of life in type 2 diabetic patients is affected by complications but not by intensive policies to improve blood glucose or blood pressure control (UKPDS 37). UK Prospective Diabetes Study Group. Diabetes Care 1999; 22: 1125 - 1136. Little RJ & Rubin DB. Statistical Analysis with Missing Data. New York: John Wiley and Sons, 1987. 1995; 85 2000; 355 1991; 34 2000; 23 1995; 25 1998; 317 1998; 339 1987 1998 1997 1999; 22 1996 1996; 276 1999; 354 2001; 44 ADA. (e_1_2_6_2_2) 2000; 23 Gold MR (e_1_2_6_12_2) 1996 Little RJ (e_1_2_6_10_2) 1987 e_1_2_6_8_2 e_1_2_6_7_2 e_1_2_6_18_2 UKPDS Group. (e_1_2_6_6_2) 1998; 317 e_1_2_6_9_2 Maritz FJ (e_1_2_6_13_2) 1995; 85 e_1_2_6_3_2 UKPDS Group. (e_1_2_6_4_2) 1998; 317 e_1_2_6_5_2 DCCT. (e_1_2_6_17_2) 1996; 276 e_1_2_6_11_2 e_1_2_6_16_2 e_1_2_6_14_2 e_1_2_6_15_2 |
| References_xml | – reference: UKPDS Group. Efficacy of atenolol and captopril in reducing risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 39. UK Prospective Diabetes Study Group. BMJ 1998; 317: 713 - 720. – reference: Wright JC & Weinstein MC. Gains in life expectancy from medical interventions-standardizing data on outcomes. N Engl J Med 1998; 339: 380 - 386. – reference: Maritz FJ, Weich HF, Schoeman HS. A comparison of the metabolic effects of captopril and atenolol on glucose, insulin and lipoproteins in patients with mild-to-moderate essential hypertension. S Afr Med J 1995; 85: 1342 - 1345. – reference: Gold MR, Siegel JE, Russell LB, Weinstein MC. Cost-Effectiveness in Health and Medicine. New York: Oxford University Press, 1996. – reference: UKPDS Group. UK Prospective Diabetes Study VIII: study design, progress and performance. Diabetologia 1991; 34: 877 - 890. – reference: UKPDS Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. UK Prospective Diabetes Study Group. BMJ 1998; 317: 703 - 713. – reference: DCCT. Lifetime benefits and costs of intensive therapy as practiced in the diabetes control and complications trial. The Diabetes Control and Complications Trial Research Group. JAMA 1996; 276: 1409 - 1415. – reference: Hansson L, Lindholm LH, Ekbom T, Dahlof B, Lanke J, Schersten B et al. Randomised trial of old and new antihypertensive drugs in elderly patients: cardiovascular mortality and morbidity the Swedish Trial in Old Patients with Hypertension-2 study. Lancet 1999; 354: 1751 - 1756.DOI: 10.1016/s0140-6736(99)10327-1 – reference: Heart Outcomes Prevention Evaluation Study Investigators. Effects of ramipril on cardiovascular and microvascular outcomes in people with diabetes mellitus: results of the HOPE study and MICRO-HOPE susbstudy. Lancet 2000; 355: 253 - 258.DOI: 10.1016/s0140-6736(99)12323-7 – reference: Viskin S, Kitzis I, Lev E, Zak Z, Heller K, Villa Y et al. Treatment with beta-adrenergic blocking agents after myocardial infarction: from randomized trials to clinical practice. J Am Coll Cardiol 1995; 25: 1327 - 1332.DOI: 10.1016/0735-1097(94)00552-2 – reference: Schafer JL. Analysis of Incomplete Multivariate Data. London: Chapman & Hall, 1997. – reference: ADA. American Diabetes Association: clinical practice recommendations 2000. Diabetes Care 2000; 23: S1 - 114. – reference: Little RJ & Rubin DB. Statistical Analysis with Missing Data. New York: John Wiley and Sons, 1987. – reference: UKPDS. Quality of life in type 2 diabetic patients is affected by complications but not by intensive policies to improve blood glucose or blood pressure control (UKPDS 37). UK Prospective Diabetes Study Group. Diabetes Care 1999; 22: 1125 - 1136. – reference: UKPDS Group. Cost effectiveness analysis of improved blood pressure control in hypertensive patients with type 2 diabetes: UKPDS 40. UK Prospective Diabetes Study Group. BMJ 1998; 317: 720 - 726. – volume: 276 start-page: 1409 year: 1996 end-page: 1415 article-title: Lifetime benefits and costs of intensive therapy as practiced in the diabetes control and complications trial. The Diabetes Control and Complications Trial Research Group publication-title: JAMA – volume: 317 start-page: 713 year: 1998 end-page: 720 article-title: Efficacy of atenolol and captopril in reducing risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 39. UK Prospective Diabetes Study Group publication-title: BMJ – volume: 354 start-page: 1751 year: 1999 end-page: 1756 article-title: Randomised trial of old and new antihypertensive drugs in elderly patients: cardiovascular mortality and morbidity the Swedish Trial in Old Patients with Hypertension‐2 study publication-title: Lancet – year: 1987 – volume: 339 start-page: 380 year: 1998 end-page: 386 article-title: Gains in life expectancy from medical interventions—standardizing data on outcomes publication-title: N Engl J Med – volume: 23 start-page: S1 year: 2000 end-page: 114 article-title: American Diabetes Association: clinical practice recommendations 2000 publication-title: Diabetes Care – year: 1997 – volume: 355 start-page: 253 year: 2000 end-page: 258 article-title: Effects of ramipril on cardiovascular and microvascular outcomes in people with diabetes mellitus: results of the HOPE study and MICRO‐HOPE susbstudy publication-title: Lancet – year: 1996 – volume: 34 start-page: 877 year: 1991 end-page: 890 article-title: UK Prospective Diabetes Study VIII: study design, progress and performance publication-title: Diabetologia – volume: 317 start-page: 720 year: 1998 end-page: 726 article-title: Cost effectiveness analysis of improved blood pressure control in hypertensive patients with type 2 diabetes: UKPDS 40. UK Prospective Diabetes Study Group publication-title: BMJ – volume: 44 start-page: 298 year: 2001 end-page: 304 – volume: 85 start-page: 1342 year: 1995 end-page: 1345 article-title: A comparison of the metabolic effects of captopril and atenolol on glucose, insulin and lipoproteins in patients with mild‐to‐moderate essential hypertension publication-title: S Afr Med J – volume: 22 start-page: 1125 year: 1999 end-page: 1136 article-title: Quality of life in type 2 diabetic patients is affected by complications but not by intensive policies to improve blood glucose or blood pressure control (UKPDS 37). UK Prospective Diabetes Study Group publication-title: Diabetes Care – volume: 317 start-page: 703 year: 1998 end-page: 713 article-title: Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. 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To compare the net cost of a tight blood pressure control policy with an angiotensin converting enzyme inhibitor (captopril) or β blocker (atenolol) in... To compare the net cost of a tight blood pressure control policy with an angiotensin converting enzyme inhibitor (captopril) or beta blocker (atenolol) in... |
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| SubjectTerms | Adrenergic beta-Antagonists - economics Adrenergic beta-Antagonists - therapeutic use Angiotensin-Converting Enzyme Inhibitors - economics Angiotensin-Converting Enzyme Inhibitors - therapeutic use Associated diseases and complications atenolol Atenolol - economics Atenolol - therapeutic use Biological and medical sciences captopril Captopril - economics Captopril - therapeutic use Confidence Intervals cost Cost-Benefit Analysis Diabetes Mellitus, Type 2 - complications Diabetes Mellitus, Type 2 - drug therapy Diabetes Mellitus, Type 2 - economics Diabetes Mellitus, Type 2 - physiopathology Diabetes. Impaired glucose tolerance economic evaluation Endocrine pancreas. Apud cells (diseases) Endocrinopathies Family Practice - economics Follow-Up Studies Glycated Hemoglobin A - analysis Hospitalization - economics Humans hypertension Hypertension - complications Hypertension - drug therapy Hypertension - economics Hypoglycemic Agents - economics Hypoglycemic Agents - therapeutic use Medical sciences Time Factors Treatment Outcome Type 2 diabetes United Kingdom |
| Title | An economic evaluation of atenolol vs. captopril in patients with Type 2 diabetes (UKPDS 54) |
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