Cost-effectiveness of irbesartan/hydrochlorothiazide in patients with hypertension: an economic evaluation for Sweden.

Irbesartan, an angiotensin-II inhibitor, has been shown to be an effective antihypertensive agent in clinical trials. The purpose of this study was to assess the cost-effectiveness of irbesartan in combination with hydrochlorothiazide (HCTZ) in Swedish health-care setting by predicting clinical events and life years based upon observed reductions in blood pressure in clinical trials. The cost-effectiveness of antihypertensive treatment with irbesartan compared with placebo and to other selected angiotensin-II inhibitors (losartan, valsartan, candesartan) in combination with HCTZ was estimated using a Markov model. The incidence of cardiovascular disease was obtained from the Swedish inpatient registry, whereas the risk reductions associated with antihypertensive therapy were taken from the medical literature. Costs for antihypertensive therapy and for treatment of cardiovascular events were included, and the health effects were measured in terms of quality-adjusted life years (QALYs). The study was conducted from a health-care payer perspective. For a 55-year-old male, irbesartan 150 mg/HCTZ 12.5 mg was a dominant strategy (better health effects at lower costs) when compared with losartan 50 mg/HCTZ 12.5 mg and valsartan 80 mg/HCTZ 12.5 mg, and the cost-effectiveness ratio compared with placebo was 3500 euros per QALY gained. In moderate-to-severe hypertension, irbesartan was cost-effective compared with losartan, whereas the results compared with candesartan were mixed. High-dose combination therapy of irbesartan was also found to be cost-effective compared with low-dose combination therapy. The results from the model indicate that irbesartan provides a cost-effective antihypertensive treatment strategy compared with both placebo, and to valsartan and losartan.

Telithromycin is as effective as amoxicillin/clavulanate in acute exacerbations of chronic bronchitis.

This randomized, double-blind study evaluated the efficacy and safety of a short, 5-day course of telithromycin, a new ketolide antibacterial, compared with a standard 10-day course of amoxicillin/clavulanate, in the treatment of acute exacerbations of chronic bronchitis (AECB). The study enrolled 325 adult patients with AECB and a history of chronic obstructive pulmonary disease (COPD). Patients received either telithromycin 800 mg once daily (qd) for 5 days (followed by placebo for 5 days) or amoxicillin/clavulanate 500/125 mg three times daily (tid) for 10 days. Clinical cure rates for telithromycin post-therapy (Days 17-21, test-of-cure) and late post-therapy (Days 31-36) were 86.1 and 78.1%, respectively; 82.1 and 75.0% for amoxicillin/clavulanate. Excellent clinical cure rates were also observed for high-risk patients. Bacteriologic outcome was satisfactory for 69.2% of telithromycin recipients vs 70.0% for amoxicillin/clavulanate recipients. Both treatments were generally well tolerated, although the frequency of drug-related adverse events was almost two-fold higher for amoxicillin/clavulanate (25.0 vs. 13.1%). Thus, a 5-day course of telithromycin 800 mg qd is an effective and well-tolerated alternative to a standard 10-day course of amoxicillin/clavulanate 500/125 mg tid for first-line empiric treatment of AECB in adults with COPD.