PharmacoEconomics & Outcomes News 622 - 19 Feb 2011

Losartan more cost effective thancandesartan - or is it?

Generic losartan appears to be more cost effectivethan candesartan for the treatment of hypertension andheart failure, according to researchers from the UK.1

They say that using the generic could save the UK NHSroughly £200 million/year.

The researchers conducted a meta-analysis andsystematic review of randomised controlled trialsinvestigating the use of losartan and candesartan inpatients with hypertension or heart failure. The primaryendpoints* were determined and a cost-utility analysis,using a Markov model over a 10-year time horizon, wasperformed. Costs and outcomes were discounted at arate of 3.5%/year.

Losartan was associated with a cost effectiveness of£44 930/QALY compared with £53 804/QALY forcandesartan, in patients with moderate hypertension.The researchers say they "could find no robust evidencesupporting the superiority of candesartan over losartanin the treatment of heart failure". They recommend thatlosartan should be the angiotensin II receptor blocker ofchoice for the UK’s NHS.

In an accompanying editorial, however, B Pitt and SJulius of the University of Michigan, heed caution wheninterpreting these results.2 They say that whilst thesubstitution of a brand name drug, candesartan, with thegeneric losartan may cut costs they fear that the impactthis may have on the incidence of stroke is immense.They claim that the meta-analysis failed to identify theincidence of stroke among the patients and that the extra2-3 mmHg reduction in BP associated with candesartandoes have a difference in stroke outcome over a longertime horizon. They finished by saying that it would "betragic in this era of limited economic resources if wetraded a short-term potential saving in healthcare costsfor a real increase in long-term costs and cardiovascularrisk".* BP change for hypertension trials, and a composite of hospitaladmission and cardiovascular death for heart failure trials.

1. Grosso AM, et al. Comparative clinical- and cost-effectiveness of candesartanand losartan in the management of hypertension and heart failure: a systematicreview, meta- and cost-utility analysis. International Journal of Clinical Practice: Feb 2011. Available from: URL: http://dx.doi.org/10.1111/j.1742-1241.2011.02633.x.

2. Pitt B, et al. Easy money?: Health cost savings resulting from the switch from abranded drug to a low-cost generic drug in the same class. International Journalof Clinical Practice : Feb 2011. Available from: URL: http://dx.doi.org/10.1111/j.1742-1241.2011.02642.x.

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PharmacoEconomics & Outcomes News 19 Feb 2011 No. 6221173-5503/10/0622-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved