Cost-Effectiveness Analysis of the Use of the Antihypertensive Drugs Candesartan and Ramipril in Hospitalized Patients with Heart Failure and Hypertension

Heart failure is a complex syndrome that prevents the ventricles from pumping blood effectively. The high prevalence of heart failure in patients with hypertension and the need for long-term therapy increase healthcare costs, making clinical and economic evaluation necessary. This study aims to determine the cost-effectiveness of in hospital antihypertensive therapy at Dr. Moewardi General Hospital in Surakarta. This study is a non-experimental study with an analytical observational design and a retrospective approach. Data were obtained from medical records and cost data for inpatients with heart failure and hypertension admitted between January 2025 and December 2025. The data obtained were analyzed using descriptive analysis, therapeutic efficacy analysis, cost-effectiveness analysis, statistical analysis, and sensitivity analysis. The study results showed that the average reduction in Mean Arterial Pressure (ΔMAP) with ramipril therapy was 20.45 mmHg, which was higher than the 17.42 mmHg reduction observed with candesartan. The ACER value for ramipril was IDR 941,574/mmHg from the hospital’s perspective and IDR 968,730/mmHg from the Health Social Security Administering Agency perspective, which were lower than those for candesartan, at IDR 1,241,209/mmHg and IDR 1,323,003/mmHg, respectively. The ICER values of −IDR 781,079/mmHg from the hospital’s perspective and −IDR 1,068,045/mmHg from the Health Social Security Administering Agency perspective indicate that ramipril is dominant. The differences in effectiveness and total cost were not statistically significant (p > 0.05). Sensitivity analysis shows that the costs of medical devices and medical procedures have the greatest impact on total costs. It can be concluded that, based on the results of the cost-effectiveness analysis, ramipril therapy is more cost-effective than candesartan from both perspectives.