South African Medical Journal

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Angiotensin converting enzyme inhibitors v. angiotensin receptor blockers in the management of hypertension: A funder’s perspective

JL Makkink, OBW Greeff


Background. Hypertension poses a huge financial risk to any funder/medical aid, including the risk-mitigating strategies provided by the managed care organisations that are required to manage patients with hypertension. The South African Hypertension Guideline states that the choice of therapy – an angiotensin converting enzyme inhibitor (ACEI) or an angiotensin receptor blocker (ARB) – should be based on cost and tolerability.
Objective. To assess the costs of ACEIs v. ARBs in the management of hypertensive patients and the prevention of cardiovascular complications for a private medical aid scheme in South Africa.
Method. A Phase IV observational, retrospective cohort study of over 480 000 beneficiaries between 2010 and 2011 was undertaken. Hypertensive patients were identified by their chronic medication authorisation and were categorised into three groups: ACEI, ARB and combined groups. A cost-benefit analysis was performed on the claims data, comparing the input costs in rand against the downstream costs using analysis of  variance.
Results. Data from 28 165 patients were included in the study. Based on the health economic analysis that was performed, there was no statistically significant difference in the input costs between the ACEI and the ARB groups. However, a statistically significant reduction in the downstream costs was observed in the ACEI group v. the ARB and combined groups (p<0.0001).
Conclusion. It is more cost beneficial to treat chronic hypertensive patients with an ACEI than ARBs in preventing cardiovascular-related complications. It is recommended that managed care companies continue recommending ACEIs rather than ARBs in the treatment of hypertensive patients.
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