Objective: To compare the cost effectiveness of an amlodipine-based strategy and an atenolol-based strategy in the treatment of hypertension in the UK and Sweden.
Design: A prospective, randomised trial complemented with a Markov model to assess long-term costs and health effects.
Setting: Primary care.
Patients: Patients with moderate hypertension and three or more additional risk factors.
Interventions: Amlodipine 5-10 mg with perindopril 4-8 mg added as needed or atenolol 50-100 mg with bendroflumethiazide 1.25-2.5 mg and potassium added as needed
Main outcome measures: Cost per cardiovascular event and procedure avoided, and cost per quality-adjusted life-year gained.
Results: In the UK, the cost to avoid one cardiovascular event or procedure would be euro18 965, and the cost to gain one quality-adjusted life-year would be euro21 875. The corresponding figures for Sweden were euro13 210 and euro16 856.
Conclusions: Compared with the thresholds applied by NICE and in the Swedish National Board of Health and Welfare's Guidelines for Cardiac Care, an amlodipine-based regimen is cost effective for the treatment of hypertension compared with an atenolol-based regimen in the population studied.