EE310 Cost-Effectiveness of Initiating Antihypertensive Therapy with Single-Pill Combinations Versus Monotherapy in US Adults

To compare the cost-effectiveness of initiating antihypertensive therapy using a dual-therapy, single-pill combination (SPC) product versus monotherapy in US adults newly diagnosed with hypertension. A discrete event simulation version of the Cardiovascular Disease (CVD) Policy Model was used to simulate BP-related healthcare processes. The model projected BP changes, medication-related adverse events, CVD events, and survival over 10 years. A nationally representative population of 10,000 US adults from the National Health and Nutrition Examination Survey was simulated. We included participants aged ≥20 years with untreated and uncontrolled BP, guideline-eligible for antihypertensive treatment, and with no CVD history. We compared initiating treatment with an SPC containing two half-standard doses vs. one half-standard dose monotherapy. All costs are in 2021 USD. Future costs and quality-adjusted life years (QALYs) were discounted 3% annually. One-way sensitivity analyses were used to examine parameter uncertainty. Uncertainty intervals (UIs) were derived from 100 probabilistic iterations of the model. At baseline, the population had a mean age of 54.8 years, 41.1% were female, and mean BP was 144.9/81.8 mmHg. At 10 years, mean systolic BP was 6.9 (95%UI 6.2 to 7.5) mmHg lower when initiating SPC vs. monotherapy. Relative to initiating monotherapy, SPC increased mean antihypertensive medication costs by $506 (95%UI $428 to $564), reduced CVD event risk by 2.2% (95%UI 1.2% to 3.1%), and decreased CVD costs by $947 (95%UI $441 to $1,380). Overall, initiating SPC was estimated to cost $490 (95%UI -$1,242 to $263) less and yield 0.02 (95%UI -0.01 to 0.04) more QALYs relative to monotherapy. The model was sensitive to pill-taking adherence and probability of intensifying therapy when BP is uncontrolled. In US adults newly diagnosed with hypertension and without CVD comorbidities, initiating treatment with SPCs may improve BP outcomes, reduce costs, and improve QALYs compared with monotherapy.