Comparators:A justification was given for the comparators used. The alternative, that no drug treatment was given, is reasonable in the case of hypertension. Also diuretics and beta-blockers represent standard treatment for incremental analysis of ACE-inhibitors and calcium-antagonists.
Estimate of Benefits:The outcome data was based on a soundly conducted review of good quality controlled trials. However, the benefit of ACE-inhibitors was based on the effect on blood pressure and not from trials of mortality.
Estimate of Costs:The resource quantities were not reported. The costing methods were not reported in adequate detail. However, no important cost items seem to have been omitted.
Other Issues:The conclusions seem justified, but rather general. The generalisability of results to other countries was not addressed explicitly. No comparisons with other economic evaluations of treating hypertension were made. Results were not presented selectively. The computerised model was used to produce cost-effectiveness estimates, and the results were not reported in an adequately transparent manner. Cost and effectiveness results of the estimation were not reported separately. No discussion was provided on the validity and relevance of the meta-analysis on which the calculations were based. The treatment period in the cost-effectiveness model was one year, while the average time in reviewed trials was 5 years.