Hypertension quadpill cost effective: Study

Michelle Wisbey

7/08/2023 4:10:51 PM

A four-in-one high blood pressure pill would be an impactful and cost-effective addition to the Australian market, according to research.

Patient wearing blood pressure monitor.
Around one third all Australians aged over 18 are currently living with high blood pressure.

A new, more effective quadpill could be on the way for high blood pressure sufferers, comparable in cost to Australia’s current offerings.
As part of the George Institute for Global Health’s QUARTET trial, the ultra-low-dose, four-in-one hypertension pill is made up of four commonly used medications: irbesartan, amlodipine, indapamide, and bisoprolol.
The trial’s initial findings previously revealed the quadpill brought blood pressure under control in 80% of participants in 12 weeks, compared to 60% in the control group.
Its most recent research sought to examine the pill’s efficacy and safety, as well as the current costs of medicines and healthcare appointments across Australia.
Lead author Dr Emily Atkins said there are opportunities for improvement across the nation to reduce preventable death and disease from high blood pressure.
‘The traditional treatment approach, recommended in the Australian guidelines for hypertension, is initially to use a single agent for most people, only moving onto combination treatment if they fail to achieve targeted reductions,’ she said.
‘But this rarely achieves sustained control.’
Meanwhile, University of Melbourne General Practice Associate Professor Ralph Audehm told newsGP hypertension management in Australia could be improved.
‘Polypharmacy is always an issue with compliance and expense,’ he said. ‘Drug combinations often make the medication more affordable and less confronting as the number of tablets are reduced.
‘Medication from different classes at lower doses [also] often have a complementary impact and control blood pressure better.’
According to the Australian Institute of Health and Welfare, around 6% of the total burden of disease in Australia can be attributed to high blood pressure.
Around one third of all people aged 18 and over currently live with hypertension; 23% with uncontrolled high blood pressure, and 11% with the condition controlled using medication.
To determine the cost of a potential quadpill, researchers calculated the cost of care for 591 Australian adults with high blood pressure, who were either receiving monotherapy or no treatment at all.
Half of the participants had a treatment approach that began with the quadpill, while the other half began with a single blood pressure lowering drug at a normal dose.
The results found the average cost per person over 12 weeks in the quadpill group was $342, and in the monotherapy group was $277 – a difference of just $65.
The study also predicted that the improved blood pressure reduction in the quadpill group would reduce lifetime incidence of heart attack, saving money over the long-term.
‘In people with medium or high cardiovascular risk in particular, it was projected the quadpill would cost less and be more effective than usual care,’ the study concluded.
However, while Associate Professor Audehm said a quadpill would be a useful addition to Australia’s healthcare offerings, he also raised a potential issue with the greater adoption of a quadpill: titration.
‘Will the quadpill be used first-line and will it have too much impact?’ he questioned.
‘Usually, a doctor would start a single medication, then add a second in, and so on. Many tablets these days allow you to uptitrate on medications included in one pill.’
The pill is not currently being manufactured, but a recent large-scale Australian trial using combinations of very low-doses in one capsule found the benefits are maintained to 12 months without any reduction.
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Dr Alan Robert McLean   8/08/2023 5:47:28 AM

At last, however I was hoping for ACE/diuretic/aspirin/statin quad, I think this would prevent more events. Less contraindications if leave B blocker out, and there are few benefits from CCB anyway