Cost-Effectiveness of Blood Pressure Treatment Guidelines in Adults 35-74

In this article the authors used the CVD Policy Model to compare the cost-effectiveness of conservative versus intensive blood pressure treatment guidelines in adult hypertensive patients aged 35 to 74 years. Outcomes included in the study were CVD events, treatment costs, quality-adjusted life years, and drug and monitoring costs projected over the years 2016 to 2026.

The effectiveness and costs of hypertension were calculated for treatment according to the 2003 Joint National Committee (JNC)-7 or 2014 JNC8 guidelines, and then for adults aged ≥ 50 years, the authors assessed the cost-effectiveness 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%. Results indicated that JNC7 strategies treated more patients and were costlier to implement compared with JNC8 strategies. Adding intensive systolic blood pressure goals for high-risk patients prevented an estimated 43,000 and 35,000 annual CVD events incremental to JNC8 and JNC7, respectively.

Intensive strategies saved costs in men and were cost-effective 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.

Based on these findings the authors concluded that 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.