Pharmacoeconomic analysis of the modern inhibitors of the renin‑angiotensin system in patients with arterial hypertension in the Russian Federation

Abstract

Objective. To evaluate the cost-effectiveness of the use of modern inhibitors of the renin-angiotensinaldosterone system (RAAS) in patients with arterial hypertension (HTN) in the Russian Federation.Design and methods. An analytical decision-making model was built in MS Excel, which enables to evaluate the additional benefit in reducing blood pressure and preventing cardiovascular outcomes when prescribing the most effective RAAS inhibitors in patients with HTN over 65 years of age on the background of antihypertensive therapy (AHT) (as a basic RAAS blocker the following agents were considered: valsartan 80 mg, enalapril 20–40 mg, lisinopril 10–20 mg, perindopril 2,5–5 mg, candesartan 8–32 mg, irbesartan 150 mg, losartan 50–100 mg, olmesartan 10 mg and telmisartan 40 mg).Results. Azilsartan medoxomil 80 mg is the most effective and will prevent 3,86 cases of myocardial infarction, 2,48 cases of acute cerebrovascular accident and 1,66 deaths from all causes per 1000 patient-years. At the same time, reducing the cost of managing complications and saving lives makes therapy with modern RAAS inhibitors economically feasible, reducing the total costs of illness. Taking into account the direct costs of treating adverse events, as well as the indirect costs of disability benefits and gross domestic product losses, the maximum potential savings can be achieved when using irbesartan 300 mg — 10,384,47 rubles/year of therapy, azilsartan 20 mg — 9 035,90 rubles/year of therapy, azilsartan 40 mg — 8 500,82 rubles/year of therapy, azilsartan 80 mg — 8 384,14 rubles/year of therapy, telmisartan 80 mg — 8 721,41 rubles/year of therapy and candesartan 32 mg — 8 204,21 rubles/year of therapy.Conclusions. The use of modern RAAS inhibitors, including azilsartan medoxomil in hypertensive patients, leads to a reduction in healthcare costs, the achievement of the targets of the national project “Fight against cardiovascular diseases”, while significantly improving the prognosis of patients and their quality of life.