Key result
Captopril-amlodipine-metformin shows no significant cost-effectiveness benefit in hospitalized hypertension and diabetes.
Why the study?
Hypertension with diabetes mellitus increases clinical complexity and healthcare expenditures, and the use of various antihypertensive and antidiabetic combination therapies in hospitalized patients requires pharmacoeconomic evaluation to determine the most cost-effective treatment option.
Is the combination of captopril, amlodipine, and metformin more cost-effective than amlodipine, candesartan, bisoprolol, metformin, and glimepiride in hospitalized patients with hypertension and diabetes mellitus complications?
Observational (n=9)
No
Is the combination of captopril, amlodipine, and metformin more cost-effective than amlodipine, candesartan, bisoprolol, metformin, and glimepiride in hospitalized patients with hypertension and diabetes mellitus complications?
Answers are grounded in this paper and cite their sources.
In a very small retrospective cohort (n=9) of hospitalized patients with hypertension and diabetes in Indonesia, a simpler three-drug regimen (captopril, amlodipine, metformin) was associated with lower inpatient costs and a more favorable cost-effectiveness ratio than a five-drug regimen, though unadjusted confounding precludes definitive conclusions.
Hypertension with diabetes mellitus (DM) is a frequent comorbidity that increases clinical complexity and healthcare expenditures. Various antihypertensive and antidiabetic combination therapies are used in hospitalized patients, making pharmacoeconomic evaluation necessary to determine the most cost-effective treatment option. This study aimed to evaluate the cost-effectiveness of hypertension treatment with diabetes mellitus complications in hospitalized patients at Berkah Pandeglang Regional Hospital. This was a non-experimental observational study with a retrospective design using secondary data from medical records and hospital billing data of hospitalized patients diagnosed with hypertension and DM in 2024. Direct medical costs and clinical effectiveness outcomes, including blood pressure control, blood glucose levels, and length of stay (LOS), were analyzed. Cost-effectiveness was assessed using the Average Cost-Effectiveness Ratio (ACER) and Incremental Cost-Effectiveness Ratio (ICER). A total of 9 patients met the inclusion criteria. Of these, 5 patients received captopril, amlodipine, and metformin, while 4 patients received amlodipine, candesartan, bisoprolol, metformin, and glimepiride. The combination therapy of captopril and amlodipine with metformin showed the lowest ACER value (IDR 25,941), indicating the most cost-effective regimen. Another combination consisting of amlodipine, candesartan, and bisoprolol with metformin and glimepiride had a higher ACER value (IDR 82,621). Both regimens were located in quadrant II of the cost-effectiveness plane, representing lower costs with higher effectiveness. The combination of captopril, amlodipine, and metformin was identified as the most cost-effective therapy for hospitalized patients with hypertension and diabetes mellitus complications at Berkah Pandeglang Regional Hospital.
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Yusransyah et al. (2026) conducted an observational in Hypertension with diabetes mellitus complications (n=9). Captopril, amlodipine, and metformin combination therapy vs. Amlodipine, candesartan, bisoprolol, metformin, and glimepiride combination therapy was evaluated on Average Cost-Effectiveness Ratio (ACER) and direct medical costs (p=0.317). Captopril, amlodipine, and metformin combination therapy achieved a lower Average Cost-Effectiveness Ratio (IDR 25,941 vs IDR 82,621) in hospitalized patients with hypertension and diabetes.
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