Cost-Effectiveness of Intensive versus Standard Blood-Pressure Control
2017
Based on data from the Systolic Blood Pressure Intervention Trial (SPRINT), the authors of this article compared the cost-effectiveness of intensive versus standard control in adults at high risk for cardiovascular disease who received intensive systolic blood-pressure control. A microsimulation model was used to project lifetime costs of treatment and monitoring, cardiovascular disease events and subsequent treatment costs, treatment-related risks of serious adverse events and subsequent costs, and quality-adjusted life-years (QALYs) for the two strategies.
Results demonstrated that the mean number of QALYs would be 0.27 higher among patients who received intensive control than among those who received standard control and would cost approximately $47,000 more per QALY gained if there were a reduction in adherence and treatment effects after 5 years; the cost would be approximately $28,000 more per QALY gained if the treatment effects persisted for the remaining lifetime of the patient. Intensive treatment would be cost-effective (51 to 79% below the willingness-to-pay threshold of $50,000 per QALY and 76 to 93% below the threshold of $100,000 per QALY), regardless of whether treatment effects were reduced after 5 years or persisted for the remaining lifetime.
Based on these findings the authors conclude that intensive systolic blood-pressure control prevented cardiovascular disease events and prolonged life and did so at levels below common willingness-to-pay thresholds per QALY, regardless of whether benefits were reduced after 5 years or persisted for the patient’s remaining lifetime.
Cost-Effectiveness of Intensive versus Standard Blood-Pressure Control
Source:
Bress AP, Bellows BK, King JB et al. Cost-Effectiveness of Intensive versus Standard Blood-Pressure Control. NEJM 2017; 377: 745-755. https://www.nejm.org/doi/full/10.1056/NEJMsa1616035