Patients who survive a first
stroke are often left with permanent disabilities, and have significant needs for rehabilitation and
long-term care.
Antihypertensive treatment reduces the risk of cardiovascular events such as
stroke. The purpose of this study was to investigate the cost-effectiveness of
candesartan-based
antihypertensive treatment for the prevention of nonfatal
stroke. The cost-effectiveness analysis was based on data from Study on COgnition and Prognosis in the Elderly (SCOPE), where patients were randomly assigned to receive the
angiotensin receptor blocker candesartan or placebo, with open-label active
antihypertensive treatment added as needed. The analysis was carried out using a Markov model, which combined clinical and resource utilization data from SCOPE with Swedish retail prices for drugs and unit costs for in-patient stays, and outpatient visits. The cost per patient was 1949 EUR in the
candesartan group and 1578 EUR in the control group. The largest share of the cost was attributed to
antihypertensive treatment in the
candesartan group and to the long-term cost of
stroke in the control group.
Candesartan-based
antihypertensive treatment was associated with 0.0289 additional quality-adjusted life-years (QALYs) per patient and an incremental cost per QALY gained of approximately 13,000 EUR. Sensitivity analyses showed that these results were fairly stable. In conclusion, the cost per QALY gained with
candesartan-based
antihypertensive treatment lies within the range of society's willingness to pay for health gains. The results indicate that
candesartan-based
antihypertensive treatment is cost-effective for the prevention of nonfatal
stroke.