Cost-Effectiveness of Intensive Blood Pressure Management
2016
This article aimed to evaluate the cost-effectiveness of intensive blood pressure management compared with standard management among 68-year-old high-risk adults with hypertension but not diabetes. A Markov cohort model was developed to estimate lifetime costs and quality-adjusted life-years (QALYs) discounted at 3% annually. The Systolic Blood Pressure Intervention Trial (SPRINT) was used to estimate treatment effects and adverse event rates. The authors used Centers for Disease Control and Prevention Life Tables to project age- and cause-specific mortality, calibrated to rates reported in SPRINT. They also used population-based observational data to model development of heart failure, myocardial infarction, stroke, and subsequent mortality. Costs were based on published sources, Medicare data, and the National Inpatient Sample.
Results indicated that standard management yielded 9.6 QALYs and accrued $155,261 in lifetime costs, while intensive management yielded 10.5 QALYs and accrued $176,584 in costs. Intensive blood pressure management cost $23,777 per QALY gained. In a sensitivity analysis, serious adverse events would need to occur at 3 times the rate observed in SPRINT and be 3 times more common in the intensive management arm to prefer standard management. Based on these findings the authors concluded that intensive blood pressure management is cost-effective at typical thresholds for value in health care and remains so even with substantially higher adverse event rates.
Cost-Effectiveness of Intensive Blood Pressure Management
Source:
Richman IB, Fairley M, Jørgensen ME et al. Cost-Effectiveness of Intensive Blood Pressure Management. JAMA Cardiology 2016; 1 (8): 872-879. https://jamanetwork.com/journals/jamacardiology/fullarticle/2551983