A health-economic comparison of diet and drug treatment in obese men with mild hypertension

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Abstract
Objective: To compare dietary and antihypertensive drug treatment in obese men with mild hypertension in economic terms. Design: A 6-week run-in period followed by randomization to either diet or drug treatment, lasting for 1 year. Blood pressure was measured blindly and serum lipid concentrations assessed at run-in and after 1 year. A computer-based model was used in five cost-effectiveness simulations with different assumptions as to the effect upon coronary heart disease risk from the changes in diastolic blood pressure and cholesterol, both total and high-density lipoprotein. A cost—benefit analysis was also performed, calculated as willingness to pay for treatment, as assessed by questionnaire, minus total cost. Setting: Outpatient clinic in city hospital. Patients: Sixty-four men aged 40–69 years with body mass index ≥ 26kg/m2 and a diastolic blood pressure 90–104 mmHg when untreated were recruited (screening after advertisement in newspaper). Exclusion criteria were diabetes mellitus, organ damage secondary to hypertension, and diseases that might have interfered with compliance and the interpretation of results. Sixty-one patients completed the study. Interventions: Dietary treatment was based upon weight reduction and sodium restriction. Drug treatment used a stepped-care approach, with atenolol as the drug of first choice. Main outcome measures: Life years gained and willingness to pay. Results: Drug treatment was the preferred option in three of the five cost-effectiveness simulations. The cost-benefit analysis did not show any difference between the two groups. Conclusions: Non-pharmacological treatment seemed to be less cost-effective than drug treatment. However, more studies and further methodological development are needed to verify this finding.

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