***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Objective : To estimate and compare the cost-effectiveness and safety of nebivolol with sustained-release metoprolol in reducing blood pressure by 1 mm of Hg per day in hypertensive patients . Material s and Methods : This was a prospect i ve , r and omized , open label , observational analysis of cost-effectiveness , in a question naire-based fashion to compare the cost of nebivolol ( 2.5 mg , 5 mg , 10 mg ) and sustained released metoprolol succinate ( 25 mg , 50 mg , 100 mg ) in hypertensive patients using either of the two drugs . A total of 60 newly detected drug naïve hypertensive patients were considered for the comparison , of which 30 patients were prescribed nebivolol and the other 30 were prescribed metoprolol succinate as per the recommended dosage . Based on the data , statistical analysis was carried out using GraphPad Prism 5 and MS Excel Spreadsheet 2007 . Result : The cost of reducing 1 mm of Hg blood pressure per day with nebivolol was 0.60 , 0.70 , and 1.06 INR , whereas that of metoprolol succinate was 0.93 , 1.18 , and 1.25 INR at their respective equivalent doses , hence significantly lower with the nebivolol group as compared to the metoprolol group ( P < 0.05 ) . Conclusion : This pharmacoeconomic analysis shows that nebivolol is more cost-effective as compared to metoprolol when the cost per reduction in blood pressure per day is considered . This may affect the patients economically during their long-term use of these molecules for the treatment of hypertension In hypertensive patients with chronic renal disease ,  angiotensin receptor blockers ( ARBs ) are among the first-line drugs , and calcium channel blockers ( CCBs ) are recommended as a second line . We examined the effects of two therapeutic strategies using ARBs and benidipine , a CCB , on blood pressure ( BP ) , urinary albumin excretion ( UAE ) , and cost-effectiveness in hypertensive patients with albuminuria . Patients whose BP was 140/90 mmHg or higher despite treatment with low- or medium-dose ARBs were assigned r and omly to two groups . In Group A ( n=14 ) , the ARB dose was maximized and then benidipine was added until BP targets were reached ( < 130/85 mmHg ) . In Group B ( n=18 ) , benidipine was administered first and then the ARB dose was increased until BP targets were reached . The BP targets were achieved by ARB alone in 36 % of Group A patients and by the addition of benidipine in 83 % of Group B patients . Finally , BP decreased in each group , reaching the targets in 93 % of Group A patients and 94 % of Group B patients after a 4-month therapeutic period . UAE was decreased in both groups after a 4-month therapeutic period compared to the allocation period ( −33±6 % in Group A , −31±6 % in Group B ; p<0.001 , respectively ) . The monthly drug cost was higher ( 11,426±880 vs. 8,955±410 yen , p=0.012 ) and the cost-effectiveness of antihypertensive treatment was lower ( p=0.003 ) in Group A than in Group B. We conclude that the addition of benidipine to low- or medium-dose ARB is , in light of the renal protection and the cost-effectiveness of this approach , a useful therapeutic strategy for controlling BP in hypertensive patients with albuminuria Abstract Background : In the Ramipril Efficacy In Nephropathy ( REIN ) trial , ramipril significantly lowered the rate of reaching the combined end-point of doubling of baseline serum creatinine levels or end-stage renal failure ( ESRF ) . Objective : To determine the additional cost per patient-year of chronic ( long term ) dialysis avoided ( PYCDA ) when the ACE inhibitor , ramipril , was added to conventional treatment of patients with non-diabetic nephropathy and hypertension . Study perspective : Statutory Health Insurance ( SHI ) provider in Germany . Design and setting : Data from the REIN Study were used in a cost-effectiveness analysis ( CEA ) . A modelling approach was used , which was based on secondary analysis of published data , and costs were those incurred by the SHI provider ( i.e. SHI expenses ) . In the base-case analysis , average case-related SHI expenses were applied and PYCDA were quantified using the cumulative incidence of ESRF as observed in the REIN trial . Main outcome measures and results : The incremental cost-effectiveness ratios ( ICERs ) of ramipril varied between about − 76 700 deutschmarks ( DM ) and -DM81 900 per PYCDA(DM1 ≈ 0.55 US dollars ; 1999 values ) , according to the treatment periods of 1 year and 3 years , respectively . In the sensitivity analysis , the robustness of the model and its results were shown when the extent of influence of different model variables on the base-case results was investigated . First , probabilities of ESRF and PYCDA were estimated according to the Weibull method . Second , the influence of the model variables on the target variable was quantified using a deterministic model . Third , the dependency of the target variable ( ICER ) on r and om variables was described in a simulation . The cost for chronic dialysis had by far the greatest impact on the target variable , which was 28 times greater than the impact of clinical effectiveness of ramipril , i.e. the number of PYCDA . There were net savings per PYCDA with ramipril treatment after 1 , 2 and 3 years : 95 % of the 10 000 simulation steps result ed in savings of between DM69 500 and DM94 600 per PYCDA after 3 years . Conclusions : Results from this evaluation show that ramipril offers enormous savings from the perspective of the SHI provider ( third-party payer ) in Germany when added to the conventional treatment of patients with non-diabetic nephropathy and hypertension Objective To evaluate the cost-effectiveness of first-line treatments for hypertension . Background The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial ( ALLHAT ) found that first-line treatment with lisinopril or amlodipine was not significantly superior to chlorthalidone in terms of the primary endpoint , so differences in costs may be critical for optimizing decision-making . Methods Cost-effectiveness analysis was performed using bootstrap resampling to evaluate uncertainty . Results Over a patient ’s lifetime , chlorthalidone was always least expensive ( mean $ 4,802 less than amlodipine , $ 3,700 less than lisinopril ) . Amlodipine provided more life-years ( LYs ) than chlorthalidone in 84 % of bootstrap sample s ( mean 37 days ) at an incremental cost-effectiveness ratio of $ 48,400 per LY gained . Lisinopril provided fewer LYs than chlorthalidone in 55 % of bootstrap sample s ( mean 7-day loss ) despite a higher cost . At a threshold of $ 50,000 per LY gained , amlodipine was preferred in 50 % , chlorthalidone in 40 % , and lisinopril in 10 % of bootstrap sample s , but these findings were highly sensitive to the cost of amlodipine and the cost-effectiveness threshold chosen . Incorporating quality of life did not appreciably alter the results . Overall , no reasonable combination of assumptions led to 1 treatment being preferred in over 90 % of bootstrap sample s. Conclusions Initial treatment with chlorthalidone is less expensive than lisinopril or amlodipine , but amlodipine provided a nonsignificantly greater survival benefit and may be a cost-effective alternative . A r and omized trial with power to exclude “ clinical ly important ” differences in survival will often have inadequate power to determine the most cost-effective treatment Background Although angiotensin receptor blockers have different receptor binding properties , no comparative r and omized studies with cardiovascular event endpoints have been performed for this class of drugs . The aim of this study was to assess the long-term cost-effectiveness of c and esartan ( Atac and ® ) versus generic losartan in the primary preventive treatment of hypertension . Methods A decision-analytic model was developed to estimate costs and health outcomes over a patient ’s lifetime . Data from a clinical registry study were used to estimate event rates for cardiovascular complications , such as myocardial infa rct ion and heart failure . Costs and quality of life data were from published sources . Costs were in Swedish kronor and the outcome was quality -adjusted life-years ( QALYs ) . Results Due to reduced rates of cardiovascular complications , c and esartan was associated with a QALY gain and lower health care costs compared with generic losartan ( 0.053 QALYs gained and reduced costs of approximately 4700 Swedish kronor for women ; and 0.057 QALYs gained and reduced costs of approximately 4250 Swedish kronor for men ) . This result was robust in several sensitivity analyses . Conclusion When modeling costs and health outcomes based on event rates for cardiovascular complications from a real-world registry study , c and esartan appears to bring a QALY gain and a reduction in costs compared with generic losartan in the primary preventive treatment of hypertension in Sweden BACKGROUND The Losartan Intervention For Endpoint reduction ( LIFE ) study was a r and omized , doubleblind trial that compared the effects of losartan-based treatment with those of atenolol-based treatment on cardiovascular disease (CVD)-related morbidity and mortality in 9193 patients with hypertension and left-ventricular hypertrophy ( LVH ) . Compared with atenolol , losartan reduced the combined risk for CVD-related morbidity and mortality by 13 % ( P = 0.021 ) , and reduced the risk for stroke by 25 % ( P = 0.001 ) , with comparable blood pressure control in both trial arms . OBJECTIVE The aim of this study was to analyze the cost-effectiveness of losartan compared with atenolol in the treatment of stroke from the Dutch health care perspective . METHODS Utilization of losartan and atenolol within the trial period ( mean , 4.8 years ) and an estimation of direct medical costs of stroke for The Netherl and s were combined with estimates of reduction in life expectancy through stroke . Medication costs and stroke incidence during 5.5 years of patient follow-up were estimated separately , adjusted for the baseline degree of LVH and Framingham risk score . To estimate lifetime stroke costs , the cumulative incidence of stroke was multiplied by the lifetime direct medical costs attributable to stroke . All costs are in 2006 Dutch prices and discounted following the former ( 4 % costs and effects ) and new Dutch guideline ( 4 % costs , 1.5 % effects ) for conducting pharmacoeconomic analyses . RESULTS With 4 % discounting , prevention of stroke was associated with a gain of 3.7 life-years . As a consequence , losartan treatment was associated with 0.059 life-year gained ( LYG ) per patient treated with losartan . Losartan  reduced stroke-related costs by 1,076 Euros ( US $ 1,349 ) per patient . After inclusion of study medication cost , net cost per patient was 51 Euros ( $ 64 ) higher for losartan than atenolol . The net cost per LYG was 864 Euros ( $ 1083 ) , which is below the Dutch pharmacoeconomic threshold of 20,000 Euros/LYG ( ~$25,000/LYG ) for accepting interventions . The corresponding probability of a cost-effectiveness ratio below this Dutch threshold was 0.95 . Discounting money and health following the new Dutch guideline result ed in an even more favorable cost-effectiveness for losartan . CONCLUSIONS Results from the present analysis suggest that , in The Netherl and s , treatment with losartan compared with atenolol may well be a cost-effective intervention based on the reduced risk for stroke observed in the LIFE trial Background Systemic hypertension often accompanies chronic renal failure and can accelerate its progression to end-stage renal disease ( ESRD ) .  Adjunctive moxonidine appeared to have benefits versus adjunctive nitrendipine , in a r and omised double-blind six-month trial in hypertensive patients with advanced renal failure . To underst and the longer term effects and costs of moxonidine , a decision analytic model was developed and a cost-effectiveness analysis performed . Methods A Markov model was used to extrapolate results from the trial over three years . All patients started in a non-ESRD state . After each cycle , patients with a glomerular filtration rate below 15 ml/min had progressed to an ESRD state . The cost-effectiveness analysis was based on the Dutch healthcare perspective . The main outcome measure was incremental cost per life-year gained . The percentage of patients progressing to ESRD and cumulative costs were also compared after three years . In the base case analysis , all patients with ESRD received dialysis . Results The model predicted that after three years , 38.9 % ( 95%CI 31.8–45.8 ) of patients treated with nitrendipine progressed to ESRD compared to 7.5 % ( 95%CI 3.5–12.7 ) of patients treated with moxonidine . Treatment with st and ard antihypertensive therapy and adjunctive moxonidine was predicted to reduce the number of ESRD cases by 81 % over three years compared to adjunctive nitrendipine .  The cumulative costs per patient were significantly lower in the moxon 
    Output:
    
All antihypertensives were cost effective compared with no treatment .
ARBs appeared to be more cost effective than CCBs , ACEIs , and β-blockers .