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Title: | Fixed-combination, low-dose, triple-pill antihypertensive medication versus usual care in patients with mild-to-moderate hypertension in Sri Lanka: a within-trial and modelled economic evaluation of the TRIUMPH trial. |
Authors: | Lung, T. Jan, S. de Silva, H.A. Guggilla, R. Maulik, P.K. Naik, N. Patel, A. de Silva, A.P. Rajapakse, S. Ranasinghe, G. Prabhakaran, D. Rodgers, A. Salam, A. Selak, V. Stepien, S. Thom, S. Webster, R. Lea-Laba, T. TRIUMPH Study Group. |
Keywords: | Hypertension |
Issue Date: | 2019 |
Publisher: | The Lancet. Global health. |
Citation: | The Lancet. Global Health. 2019 ; 7(10):e1359-e1366 |
Abstract: | BACKGROUND: Elevated blood pressure incurs a major health and economic burden, particularly in low-income and middle-income countries. The Triple Pill versus Usual Care Management for Patients with Mild-to-Moderate Hypertension (TRIUMPH) trial showed a greater reduction in blood pressure in patients using fixed-combination, low-dose, triple-pill antihypertensive therapy (consisting of amlodipine, telmisartan, and chlorthalidone) than in those receiving usual care in Sri Lanka. We aimed to assess the cost-effectiveness of the triple-pill strategy. METHODS: We did a within-trial (6-month) and modelled (10-year) economic evaluation of the TRIUMPH trial, using the health system perspective. Health-care costs, reported in 2017 US dollars, were determined from trial records and published literature. A discrete-time simulation model was developed, extrapolating trial findings of reduced systolic blood pressure to 10-year health-care costs, cardiovascular disease events, and mortality. The primary outcomes were the proportion of people reaching blood pressure targets (at 6 months from baseline) and disability-adjusted life-years (DALYs) averted (at 10 years from baseline). Incremental cost-effectiveness ratios were calculated to estimate the cost per additional participant achieving target blood pressure at 6 months and cost per DALY averted over 10 years. FINDINGS: The triple-pill strategy, compared with usual care, cost an additional US$9·63 (95% CI 5·29 to 13·97) per person in the within-trial analysis and $347·75 (285·55 to 412·54) per person in the modelled analysis. Incremental cost-effectiveness ratios were estimated at $7·93 (95% CI 6·59 to 11·84) per participant reaching blood pressure targets at 6 months and $2842·79 (-28·67 to 5714·24) per DALY averted over a 10-year period. INTERPRETATION: Compared with usual care, the triple-pill strategy is cost-effective for patients with mild-to-moderate hypertension. Scaled up investment in the triple pill for hypertension management in Sri Lanka should be supported to address the high population burden of cardiovascular disease. |
Description: | Indexed for MEDLINE. |
URI: | http://repository.kln.ac.lk/handle/123456789/20483 |
ISSN: | 2214-109X (Electronic) 2214-109X (Linking) |
Appears in Collections: | Journal/Magazine Articles |
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File | Description | Size | Format | |
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Hypertention..pdf | 452.04 kB | Adobe PDF | View/Open |
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