Fixed-combination, low-dose, triple-pill antihypertensive medication versus usual care in patients with mild-to-moderate hypertension in Sri Lanka: a within-trial and modelled economic evaluation of the TRIUMPH trial

Thomas Lung, PhD; Stephen Jan, ProfPhD; H Asita de Silva, ProfPhD; Rama Guggilla, MMeD; Pallab K Maulik, PhD; Nitish Naik, MD; Anushka Patel, ProfPhD; Arjuna P de Silva, ProfMD; Senaka Rajapakse, ProfPhD; Gotabhaya Ranasinghe, MD; Dorairaj Prabhakaran, MD; Anthony Rodgers, ProfPhD; Abdul Salam, PhD; Vanessa Selak, PhD; Sandrine Stepien, MSc; Simon Thom, ProfMD; Ruth Webster, PhD; Tracey Lea-Laba, PhD

The Lancet Global Health (Oct 2019)

Fixed-combination, low-dose, triple-pill antihypertensive medication versus usual care in patients with mild-to-moderate hypertension in Sri Lanka: a within-trial and modelled economic evaluation of the TRIUMPH trial

Thomas Lung, PhD,
Stephen Jan, ProfPhD,
H Asita de Silva, ProfPhD,
Rama Guggilla, MMeD,
Pallab K Maulik, PhD,
Nitish Naik, MD,
Anushka Patel, ProfPhD,
Arjuna P de Silva, ProfMD,
Senaka Rajapakse, ProfPhD,
Gotabhaya Ranasinghe, MD,
Dorairaj Prabhakaran, MD,
Anthony Rodgers, ProfPhD,
Abdul Salam, PhD,
Vanessa Selak, PhD,
Sandrine Stepien, MSc,
Simon Thom, ProfMD,
Ruth Webster, PhD,
Tracey Lea-Laba, PhD

Affiliations

Thomas Lung, PhD: The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia; Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; Correspondence to: Dr Thomas Lung, The George Institute for Global Health, University of New South Wales, Sydney, NSW 2042, Australia
Stephen Jan, ProfPhD: The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia; Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
H Asita de Silva, ProfPhD: Clinical Trials Unit, Department of Pharmacology, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
Rama Guggilla, MMeD: Department of Population Medicine and Civilization Diseases Prevention, Faculty of Medicine with the Division of Dentistry and Division of Medical Education in English, Medical University of Bialystok, Bialystok, Poland
Pallab K Maulik, PhD: The George Institute for Global Health, University of New South Wales, New Delhi, India; The George Institute for Global Health, University of Oxford, Oxford, UK
Nitish Naik, MD: All India Institute of Medical Sciences, New Delhi, India
Anushka Patel, ProfPhD: The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
Arjuna P de Silva, ProfMD: Department of Medicines, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
Senaka Rajapakse, ProfPhD: Department of Medicines, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
Gotabhaya Ranasinghe, MD: Institute of Cardiology, National Hospital of Sri Lanka, Colombo, Sri Lanka
Dorairaj Prabhakaran, MD: Centre for Chronic Disease Control, New Delhi, India
Anthony Rodgers, ProfPhD: The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
Abdul Salam, PhD: The George Institute for Global Health, University of New South Wales, Hyderabad, India
Vanessa Selak, PhD: Department of Epidemiology and Biostatistics, University of Auckland, Auckland, New Zealand
Sandrine Stepien, MSc: The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
Simon Thom, ProfMD: International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, London, UK
Ruth Webster, PhD: The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
Tracey Lea-Laba, PhD: The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia

Journal volume & issue: Vol. 7, no. 10
pp. e1359 – e1366

Abstract

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Summary: Background: Elevated blood pressure incurs a major health and economic burden, particularly in low-income and middle-income countries. The Triple Pill versus Usual Care Management for Patients with Mild-to-Moderate Hypertension (TRIUMPH) trial showed a greater reduction in blood pressure in patients using fixed-combination, low-dose, triple-pill antihypertensive therapy (consisting of amlodipine, telmisartan, and chlorthalidone) than in those receiving usual care in Sri Lanka. We aimed to assess the cost-effectiveness of the triple-pill strategy. Methods: We did a within-trial (6-month) and modelled (10-year) economic evaluation of the TRIUMPH trial, using the health system perspective. Health-care costs, reported in 2017 US dollars, were determined from trial records and published literature. A discrete-time simulation model was developed, extrapolating trial findings of reduced systolic blood pressure to 10-year health-care costs, cardiovascular disease events, and mortality. The primary outcomes were the proportion of people reaching blood pressure targets (at 6 months from baseline) and disability-adjusted life-years (DALYs) averted (at 10 years from baseline). Incremental cost-effectiveness ratios were calculated to estimate the cost per additional participant achieving target blood pressure at 6 months and cost per DALY averted over 10 years. Findings: The triple-pill strategy, compared with usual care, cost an additional US$9·63 (95% CI 5·29 to 13·97) per person in the within-trial analysis and $347·75 (285·55 to 412·54) per person in the modelled analysis. Incremental cost-effectiveness ratios were estimated at $7·93 (95% CI 6·59 to 11·84) per participant reaching blood pressure targets at 6 months and $2842·79 (−28·67 to 5714·24) per DALY averted over a 10-year period. Interpretation: Compared with usual care, the triple-pill strategy is cost-effective for patients with mild-to-moderate hypertension. Scaled up investment in the triple pill for hypertension management in Sri Lanka should be supported to address the high population burden of cardiovascular disease. Funding: Australian National Health and Medical Research Council.

Published in The Lancet Global Health

ISSN: 2214-109X (Online)
Publisher: Elsevier
Country of publisher: United Kingdom
LCC subjects: Medicine: Public aspects of medicine
Website: http://www.lancet.com/journals/langlo/issue/current

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