DOI: https://doi.org/10.15587/2519-4852.2018.135771

Pharmacoeconomic analysis of the use of ramipril and candesartan in patients with arterial hypertension

Alena Marushchak, Evgeniy Shorikov

Abstract


Arterial hypertension (AH) is the most common cardiovascular disease in the world and is the cause of disability of the population of the developed countries of the world. A feature of hypertension pharmacotherapy is a lifelong intake of medications. Indicators of economic evaluation of the effectiveness of different methods of treatment contribute to the selection of pharmacotherapy, which will provide the patient with the highest effectiveness of treatment, taking into account the financial capabilities of a particular patient. The main objectives of antihypertensive therapy is to achieve the target level of blood pressure (BP), the protection of target organs and a positive impact on risk factors for cardiovascular complications. The "cost-effectiveness" method makes it possible to compare costs with the same therapeutic effectiveness, which was the purpose of our study.

Materials and methods. 100 protocols of medical cards of inpatients were studied. Two groups of patients were isolated: the first group for the treatment of AH received candesartan, and the second group – ramipril. The parameters were taken into account: achievement of target blood pressure, as well as possible complications of drug therapy - hypotension, cough, angioedema. To assess the cost of treatment against the background of the use of ramipril and candesartan, a "cost-effectiveness" pharmaco-economic analysis was carried out.

Results of the study. Using the "cost-effectiveness" method, an analysis of ramipril and candesartan was carried out. The minimum, average and maximum costs of a single, daily, and course dose were calculated and the cost of BP normalization was calculated. The data obtained by us indicate a lower cost of treatment with ramipril. Analysis of the effectiveness of the drugs showed that ramipril is more effective in achieving the target blood pressure, but the percentage of side effects among which heart failure and cough were significantly higher. The data obtained indicate a high therapeutic efficacy of candesartan and ramipril, which allows us to draw conclusions:

Conclusions. The most effective in achieving target BP was ramipril than candesartan. Analysis of the efficacy of drugs has established that ramipril has side effects and causes cough and heart failure, and candesartan can cause angioedema and hypotension. In analyzing the direct costs of treating hypertension, based on current standards of medical care for patients with AH, it was found that the least expensive is the treatment with ramipril. The analysis "cost-effectiveness", showed that ramipril possesses the greatest pharmaco-economic advantage

Keywords


Arterial hypertension; candesartan; ramipril; pharmaco-economic analysis; antihypertensive drugs; cost-effectiveness

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References


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GOST Style Citations


Farmakoekonomicheskaya ocenka lekarstvennogo sredstva zokardis (zofenopril) na osnove metodiki «minimizacii zatrat» / Vdovichenko V. P., Goncharuk V. V., Bronskaya G. M., Korshak T. A., Mahan'kova T. V. // Medicinskie novosti. 2014. Issue 6. P. 56–60.

Metodicheskie podhody k formirovaniyu aktual'nyh indikatorov kachestva medicinskoy pomoshchi / Yur'ev A. S., Avksent'eva M. V., Vorob'ev P. A., Gorbunov S. N. // Problemy standartizacii v zdravoohranenii. 2005. Issue 8. P. 14–21.

Farmakoekonomicheskiy analiz ispol'zovaniya azilsartana medoksomila v lechenii myagkoy i umerennoy essencial'noy gipertenzii / Nedogoda S. V., Barykina I. N., Salasyuk A. S., Smirnova V. O. // RMZh. 2016. Issue 12. P. 734–738.

Yagudina R. I., Serpik V. G., Kulikov A. Yu. Farmakoekonomika dlya organizatorov zdravoohraneniya. Algoritm prinyatiya resheniy na osnove farmakoekonomicheskoy ocenki // Farmakoekonomika: teoriya i praktika. 2014. Vol. 2, Issue 1. P. 5–12.

Tolordava G. A., Arinina E. E., Kulikov A. Yu. Farmakoekonomicheskiy analiz lekarstvennogo sredstva fozinopril u bol'nyh s arterial'noy gipertenziey // Farmakoekonomika: teoriya i praktika. 2016. Vol. 4, Issue 1. P. 70–78.

Effects of candesartan in patients with chronic heart failure and reduced left-ventricular systolic function intolerant to angiotensin-converting-enzyme inhibitors: the CHARM-Alternative trial / Granger C. B., McMurray J. J., Yusuf S., Held P., Michelson E. L., Olofsson B. et. al. // The Lancet. 2003. Vol. 362, Issue 9386. P. 772–776. doi: http://doi.org/10.1016/s0140-6736(03)14284-5 

Protective Role of Ramipril and Candesartan against Myocardial Ischemic Reperfusion Injury: A Biochemical and Transmission Electron Microscopical Study / Sheik Uduman M. S. T., Reddy R. B., Punuru P., Chakka G., Karunakaran G. // Advances in Pharmacological Sciences. 2016. Vol. 2016. P. 1–7. doi: http://doi.org/10.1155/2016/4608979 

Nikolaev N. A. Innovacionnaya antigipertenzivnaya terapiya v svete zavershennyh nauchnyh issledovaniy // Racional'naya Farmakoterapiya v Kardiologii. 2009. Issue 2. P. 89–97.

Farmakoekonomicheskaya ocenka lekarstvennogo sredstva Zokardis (ezofenopril) na osnove metodiki minimizacii zatrat / Vdovichenko V. L., Goncharuk V. V., Bronskaya G. M., Korshak T. A., Mahan'kova T. V. // Medicinskie novovsti. 2014. Issue 6. P. 56–60.

Korovina E. V. Racional'noe naznachenie antigipertenzivnyh lekarstvennyh sredstv na osnove farmakoepidemiologicheskogo analiza: avtoref. diss. … kand. med. nauk. Volgograd, 2015. 36 p.

Tolparov G. V. Vliyanie blokatorov renin-angiotenzin-al'dosteronovoy sistemy na funkcional'noe sostoyanie pravogo zheludochka pri infarkte miokarda peredney stenki levogo zheludochka // Kubanskiy nauchniy medicinskiy vestnik. 2016. Issue 3 (158). P. 126–129.

Martynyuk T. V., Chazova I. E. Preimushchestva azilsartana medoksomila u pacientov s arterial'noy gipertoniey: kak pravil'no osushchestvit' vybor i optimizirovat' antigipertenzivnuyu terapiyu? // Sistemnye gipertenzii. 2017. Vol. 14, Issue 2. P. 30–35.

A Meta-Analysis Reporting Effects of Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers in Patients Without Heart Failure / Savarese G., Costanzo P., Cleland J. G. F., Vassallo E., Ruggiero D., Rosano G., Perrone-Filardi P. // Journal of the American College of Cardiology. 2013. Vol. 61, Issue 2. P. 131–142. doi: http://doi.org/10.1016/j.jacc.2012.10.011 

Angeloni E. Azilsartan medoxomil in the management of hypertension: an evidence-based review of its place in therapy // Core Evidence. 2016. doi: http://doi.org/10.2147/ce.s81776 

Cost-effectiveness of the treatment of heart failure with ramipril: a Spanish analysis of the AIRE study / Hart W. M., Rubio-Terres C., Pajuelo F., Juanatey J. R. G. // European Journal of Heart Failure. 2002. Vol. 4, Issue 4. P. 553–558. doi: http://doi.org/10.1016/s1388-9842(02)00087-9 







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