Comparative Cost-Effectiveness of Conservative or Intensive Blood Pressure Treatment Guidelines in Adults Aged 35–74 Years

Abstract

Abstract-The population health effect and cost-effectiveness of implementing intensive blood pressure goals in highcardiovascular disease (CVD) risk adults have not been described. Using the CVD Policy Model, CVD events, treatment costs, quality-adjusted life years, and drug and monitoring costs were simulated over 2016 to 2026 for hypertensive patients aged 35 to 74 years. We projected the effectiveness and costs of hypertension treatment according to the 2003 Joint National Committee (JNC)-7 or 2014 JNC8 guidelines, and then for adults aged ≥50 years, we assessed the costeffectiveness of adding an intensive goal of systolic blood pressure <120 mm Hg for patients with CVD, chronic kidney disease, or 10-year CVD risk ≥15%. Incremental cost-effectiveness ratios <$50 000 per quality-adjusted life years gained were considered cost-effective. JNC7 strategies treat more patients and are more costly to implement compared with JNC8 strategies. Adding intensive systolic blood pressure goals for high-risk patients prevents an estimated 43 000 and 35 000 annual CVD events incremental to JNC8 and JNC7, respectively. Intensive strategies save costs in men and are costeffective in women compared with JNC8 alone. At a willingness-to-pay threshold of $50 000 per quality-adjusted life years gained, JNC8+intensive had the highest probability of cost-effectiveness in women (82%) and JNC7+intensive the highest probability of cost-effectiveness in men (100%). Assuming higher drug and monitoring costs, adding intensive goals for high-risk patients remained consistently cost-effective in men, but not always in women. Among patients aged 35 to 74 years, adding intensive blood pressure goals for high-risk groups to current national hypertension treatment guidelines prevents additional CVD deaths while saving costs provided that medication costs are controlled. (Hypertension.

Screening and Treatment for Subclinical Hypertensive Heart Disease in Emergency Department Patients With Uncontrolled Blood Pressure: A Cost‐effectiveness Analysis

“…Based on our sensitivity analysis, the true cost‐effectiveness of our approach to diagnosis and treatment of SHHD likely sits between $20,000 and $30,000 per year—a figure that is similar to recently published data by Moise et al that found more intensive BP control to be cost‐effective at <$50,000 per QALY for management of HTN, particularly in patients with cardiovascular disease, chronic kidney disease, and a 10‐year cardiovascular disease risk > 15%. In a recent perspective piece, Neumann et al argue that the $50,000 per QALY measure may indeed be too low.…”

“…A threshold cost of $50,000 per QALY is the traditional benchmark for determining the value of care. Therefore, values at or below this were adopted in our study as the measure of cost‐effectiveness . The cost per QALY was modeled by the following mathematical equation, where 0.87 and 0.71 are used as standard utility values assigned to patients for whom chronic HF (the most likely adverse consequence of untreated SHHD) would or would not be prevented by treatment, respectively:…”

“…Therefore, values at or below this were adopted in our study as the measure of cost-effectiveness. [41][42][43] The cost per QALY was modeled by the following mathematical equation, where 0.87 and 0.71 are used as standard utility values 44 assigned to patients for whom chronic HF (the most likely adverse consequence of untreated SHHD) would or would not be prevented by treatment, respectively:…”

Cost-Effectiveness of Intensive versus Standard Blood-Pressure Control

“…31,32 Moise and colleagues estimated more favorable ICERs for intensive control than for standard control among U.S. adults at high cardiovascular risk, but they did not define a high risk of cardiovascular disease strictly according to SPRINT eligibility criteria; in addition, they simulated only a 10-year time horizon and did not account for the costs of treating noncardiovascular diseases in their cost-effectiveness calculations. 31 Richman et al used a lifetime horizon, with their main cost-effectiveness estimate of approximately $24,000 per QALY gained, which was presumably based on lifetime persistence of the benefits of intensive control as defined in SPRINT. 32 Our base case assumed a reduction in treatment effects over time on the basis of standard practice for cost-effectiveness analysis of clinical trials.…”

Cost-effectiveness of Intensive Blood Pressure Management

“…16 A second recent cost-effectiveness analysis evaluated the cost-effectiveness of intensive blood pressure management in addition to current hypertension guidelines and concluded that intensive blood pressure management is cost-effective or cost-saving. 27 Our analysis adds to this body of literature by specifically incorporating the estimates of benefit and risk described in SPRINT and exploring the cost-effectiveness of intensive blood pressure management in older populations.…”