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Hoffmann, R. A wiki for the life sciences where authorship matters. Nature Genetics (2008)

Cost implications of development of diabetes in the ALPINE study.

OBJECTIVE: To present a cost-effectiveness analysis of the Antihypertensive Treatment and Lipid Profile in a North of Sweden Efficacy Evaluation study (ALPINE). DESIGN: In newly diagnosed hypertensive individuals as yet untreated with drugs, the ALPINE study compared the 1-year metabolic effects of inexpensive treatment with a diuretic (hydrochlorothiazide), alone or in combination (84%) with a beta-adrenoceptor blocker (atenolol), with that of newer but also more expensive antihypertensive treatment with an angiotensin II receptor blocker (candesartan), alone or in combination (71%) with a calcium antagonist (felodipine). No crossover of medication was allowed. The cost-effectiveness analysis included costs for antihypertensive treatment during follow-up, and lifetime costs for care of diabetes mellitus diagnosed during follow-up. Cost per patient was calculated using Swedish prices and costs, translated into US dollars (US$), at 2004 prices. RESULTS: Diabetes mellitus was diagnosed in nine patients during the 1-year follow-up period of the study, eight in the hydrochlorothiazide group (4.1%) and one (0.5%) in the candesartan/felodipine group (P < 0.05). The cost of antihypertensive treatment per patient was US$92 in the hydrochlorothiazide/atenolol group and US$422 in the candesartan/felodipine group. Lifetime cost for care of diabetes mellitus per patient in the two groups was US$1013 and US$127, respectively. Total cost per patient was US$556 less in the candesartan/felodipine group. In sensitivity analyses, the outcome for the candesartan/felodipine group ranged from cost savings to an incremental cost of US$30 000 per case of diabetes mellitus prevented. In all analyses but one, the additional cost for antihypertensive treatment in the candesartan/felodipine group could be balanced by the reduced lifetime cost for care of diabetes mellitus. CONCLUSIONS: The results suggest that an antihypertensive treatment strategy with candesartan and felodipine may have a favourable health economic impact in the longer term.[1]


  1. Cost implications of development of diabetes in the ALPINE study. Lindholm, L.H., Kartman, B., Carlberg, B., Persson, M., Svensson, A., Samuelsson, O. Journal of hypertension. Supplement : official journal of the International Society of Hypertension. (2006) [Pubmed]
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