Labetalol, Nifedipine, and Methyldopa for the Management of Hypertensive Disorders in Pregnancy in Iran: A Cost‐Effectiveness Analysis

Background and Aims: Hypertensive disorders in pregnancy create major clinical and economic burdens on maternal health services, making evidence on efficient resource allocation and cost-effectiveness essential for treatment decisions. However, no clear consensus exists on the most cost-effective antihypertensive therapy in Iran. This study evaluated the cost-effectiveness of methyldopa, labetalol, and nifedipine in pregnant women in Iran. Methods: A decision-analytic model was created using a decision tree framework to compare the cost-effectiveness of labetalol with nifedipine and methyldopa. The model used data from published randomized clinical trials and relevant literature. A hypothetical group of pregnant women aged 18 and older, at least 28 weeks pregnant, and experiencing severe hypertension (systolic blood pressure of 160 mmHg or higher, or diastolic blood pressure of 110 mmHg or higher), was studied over 4 months. The analysis considered the viewpoint of healthcare payers. Costs were measured in US dollars, and health outcomes were represented in quality-adjusted life years (QALYs). A willingness-to-pay threshold of $18,261 per QALY was set. Deterministic and probabilistic sensitivity analyses, including 10,000 Monte Carlo simulations, were conducted to evaluate uncertainty. Results: In the base-case analysis, nifedipine provided the highest QALYs (0.21), followed by labetalol (0.19) and methyldopa (0.16). The total costs were $607 for nifedipine, $500 for labetalol, and $847 for methyldopa. Labetalol was less expensive and more effective than methyldopa, making it the dominant choice. Compared to nifedipine, labetalol was not cost-effective at the specified willingness-to-pay threshold. The probabilistic sensitivity analysis revealed that labetalol was cost-effective in 70% of simulations against methyldopa and 29% against nifedipine. Conclusion: From the perspective of Iranian healthcare payers, labetalol is a cost-saving and dominant option compared to methyldopa. However, it is not cost-effective when compared to nifedipine at a willingness-to-pay threshold of $18,261 per QALY in managing hypertensive disorders during pregnancy.