1. Economic Analysis: ALLHAT Antihypertensive Trial Paul Heidenreich MD, MS ALLHAT

2. Collaborators Jeffrey Cutler Barry Davis Chuke Nwachuku Michael Shlipak Kathryn Phillips Barabara deLeon Sara Pressel Curt Furberg Lee Goldman For the ALLHAT Collaborative Research Group ALLHAT

3. Objectives To compare the medical costs for ALLHAT patients treated with: –Chlorthalidone –Amlodipine –Lisinopril To compare differences in hospitalization rates. To compare differences in quality of life. ALLHAT

4. Outline Methods –Cost Estimation Results –Resource Use –Cost Differences –Quality of Life Implications ALLHAT

5. Resource Utilization Hospitalizations –Source: case report forms Office Visits –Source: case report forms Drug Use –Source: case report forms ALLHAT

6. Estimating Costs for Patient Care Hospitalizations –Average Medicare reimbursement for each trial arm Office visits –Medicare reimbursement for Intermediate level visit ($50) Drug cost for each trial arm –Redbook (mean wholesale price) ALLHAT

7. Quality of Life Visual Analog Scale Analog Scales are not true utilities –Utility (0-1) indicates the tradeoff between length and quality of life such that: Life-expectancy*utility = Quality Adjusted Survival ALLHAT

8. Quality of Life Analog Scale Transformed (Torrance) to better represent a utility ALLHAT

9. Drug Costs (per year) Chlorthalidone $63 Amlodipine$734 Lisinopril $590 ALLHAT Source: Redbook

10. Remaining on Study Drug ALLHAT

11. Study Drug Cost ALLHAT

12. Potassium Use ALLHAT

13. Open Label Drugs (Yearly Cost) Atenolol 18% ($255) Diuretic 7.9% ($63) Clonidine 7.8% ($75) Ca Antagonist 5.4% ($734) ACE Inhibitor 5.2% ($590) Hydralazine 4.6% ($55) Doxazosin 1.5% ($386) Reserpine 3% ($49) Other 5.6% ($306) Potassium ($191) ALLHAT

14. Non-Study Drug Cost ALLHAT

15. Cost per Admission ALLHAT

16. Hospitalizations ALLHAT

17. Hospitalization Cost ALLHAT

18. Office Visits ALLHAT

19. Office Visit Cost ALLHAT

20. Total Cost ALLHAT

21. Lifetime Cost of Care DrugTotal ($)Discounted* ($) Chlorthalidone31,20025,000 Amlodipine37,80030,200 Lisinopril38,40030,800 ALLHAT * Discounted at 3% per year

22. Sensitivity Analysis Total Cost: Pharmacy Prices ALLHAT

23. Total Cost: Redbook Prices ALLHAT

24. Societal Impact of Using Chlorthalidone as the First Line Agent 30 million U.S. Hypertensives (treated) by 2005 Potential lifetime savings = Patients*Chlorthalidone Savings*Increase in Use

25. Financial Impact of Using Chlorthalidone as the First Line Agent ALLHAT

26. Mortality ALLHAT

27. Quality of Life ALLHAT

28. Limitations Not all individual drugs known –(Ca antagonists, ACE inhibitors) Lab tests not measured Quality of life measure does not tradeoff survival for quality of life. ALLHAT

29. Conclusions Lifetime cost of care is lowest for chlorthalidone group –Due to lower drug costs –Savings > $4,000 per person No significant differences in mortality or quality of life. Increase in use of thiazides will have a an important impact on cost of care. ALLHAT