Cost-effectiveness of Intensive vs Standard Blood Pressure Control Among Older Patients With Hypertension

doi:10.1001/jamanetworkopen.2023.0708

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Title:	Cost-effectiveness of Intensive vs Standard Blood Pressure Control Among Older Patients With Hypertension
Authors:	Liao, Chia-Te Toh, Han Siong Sun, Li Yang, Chun-Ting Hu, Angie Wei, Dongmei Melgarejo, Jesus Zhang, Zhen-Yu
Contributors:	Univ Leuven, Studies Coordinating Ctr, KU Leuven Dept Cardiovasc Sci, Res Unit Hypertens & Cardiovasc Epidemiol Natl Cheng Kung Univ, Coll Med, Dept Publ Hlth Chi Mei Med Ctr, Dept Internal Med, Div Cardiol Chi Mei Med Ctr, Dept Intens Care Med Natl Cheng Kung Univ, Coll Med, Inst Clin Med Chia Nan Univ Pharm & Sci, Dept Hlth & Nutr London Sch Hyg & Trop Med, Dept Hlth Serv Res & Policy Natl Cheng Kung Univ, Inst Clin Pharm & Pharmaceut Sci, Coll Med
Keywords:	American-College Guideline Prevalence Management Adherence Adults Heart Risk
Date:	2023
Issue Date:	2024-12-25 11:05:59 (UTC+8)
Publisher:	AMER MEDICAL ASSOC
Abstract:	\IMPORTANCE Older patients with hypertension receiving intensive systolic blood pressure control (110-130 mm Hg) have lower incidences of cardiovascular events than those receiving standard control (130-150 mm Hg). Nevertheless, the mortality reduction is insignificant, and intensive blood pressure management results in more medical costs from treatments and subsequent adverse events. OBJECTIVE To examine the incremental lifetime outcomes, costs, and cost-effectiveness of intensive vs standard blood pressure control in older patients with hypertension from the health care payer's perspective. DESIGN, SETTING, AND PARTICIPANTS This economic analysis was conducted with a Markov model to examine the cost-effectiveness of intensive blood pressure management among patients aged 60 to 80 years with hypertension. Treatment outcome data from the Trial of Intensive Blood-Pressure Control in Older Patients With Hypertension (STEP trial) and different cardiovascular risk assessment models for a hypothetical cohort of STEP-eligible patients were used. Costs and utilities were obtained from published sources. The incremental cost-effectiveness ratio (ICER) against the willingness-to-pay threshold was used to evaluate whether the management was cost-effective. Extensive sensitivity, subgroup, and scenario analyses were performed to address uncertainty. The US and UK population using race-specific cardiovascular risk models were conducted in the generalizability analysis. Data for the STEP trial were collected from February 10 to March 10, 2022, and were analyzed for the present study from March 10 to May 15, 2022. INTERVENTIONS Hypertension treatments with a systolic blood pressure target of 110 to 130 mm Hg or 130 to 150 mm Hg. MAIN OUTCOMES AND MEASURES Incremental lifetime quality-adjusted life-years (QALYs), costs, and ICER are discounted at the given rates annually. RESULTS After simulating 10 000 STEP-eligible patients assumed to be 66 years of age (4650 men [46.5%] and 5350 women [53.5%]) in the model, the ICER values were (sic)51 675 ($12 362) per QALY gained in China, $25 417 per QALY gained in the US, and 4679 pound ($7004) per QALY gained in the UK. Simulations projected that the intensive management in China being cost-effective were 94.3% and 100% below the willingness-to-pay thresholds of 1 time ((sic)89 300 [$21 364]/QALY) and 3 times ((sic)267 900 [$64 090]/QALY) the gross domestic product per capita, respectively. The US had 86.9% and 95.6% probabilities of cost-effectiveness at $50 000/QALY and $100 000/QALY, respectively, and the UK had 99.1% and 100% of probabilities of cost-effectiveness at 20 pound 000 ($29 940)/QALY and 30 pound 000 ($44 910)/QALY, respectively. CONCLUSIONS AND RELEVANCE In this economic evaluation, the intensive systolic blood pressure control in older patients produced fewer cardiovascular events and had acceptable costs per QALY gained, well below the typical willingness-to-pay thresholds. The cost-effective advantages of intensive blood pressure management in older patients were consistent over various clinical scenarios across different countries.
Relation:	Jama Network Open, v.6, n.2
Appears in Collections:	[Offices] 456

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