Could use of generic ARBs save the NHS millions?

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News from the world of cardiology

Substituting generic angiotensin receptor blocker (ARB), losartan, for branded ARBs could save the NHS £200 million per year without any clear decrease in clinical benefits, a new study suggests.

The systematic review and meta-and cost-utility analysis, published online on February 2nd 2011 in the International Journal of Clinical Practice, was conducted by a team led by Dr Anthony Grosso (University College London). They conclude that they could find no case to support the prescribing of branded candesartan over generic losartan in the treatment of hypertension or heart failure.

But in an accompanying editorial, Drs Bertram Pitt and Stevo Julius (University of Michigan School of Medicine, Ann Arbor, US) argue that candesartan is more effective in lowering blood pressure than losartan. They say “it would be tragic… if we traded a short-term potential saving in healthcare costs for a real increase in long-term costs and cardiovascular risk”.

Dr Grosso et al report that the UK NHS currently spends more than £250 million per year on ARBs for the treatment of hypertension and heart failure, with candesartan dominating the market. As losartan is now available generically, they compared the two drugs in the treatment of hypertension and chronic heart failure.

They say that although candesartan reduces blood pressure slightly more than losartan, this is of “questionable clinical significance”. And in heart failure, they recommend that if a patient on candesartan is not on a maximal target dose, they should change to losartan.

However, Drs Pitt and Julius retort that the difference in blood pressure-lowering ability between the two agents may have important long-term cardiovascular consequences. And in heart failure, they say that: “Even if the difference between the effectiveness of losartan and candesartan results in only a few percentage points difference in hospitalisations, given the cost of a single hospitalisation for heart failure this could negate all of the potential savings from switching…and in fact result in a substantial increase in healthcare costs that could be far greater than the postulated savings proposed by Grosso et al“.