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Cost-Effectiveness of Hypertension Therapy According to 2014 Guidelines | Journal Scan
Study Questions:
Is treating hypertension in US adults according to the 2014 guidelines cost-effective?
Methods:
The Cardiovascular Disease Policy Model was used to simulate drug treatment and monitoring costs, costs averted for the treatment of cardiovascular disease (CVD), and quality-adjusted life-years (QALYs) gained by treating previously untreated adults between the ages of 35 and 74 years from 2014 through 2024. Cost-effectiveness was assessed according to age, hypertension level, and the presence or absence of chronic kidney disease or diabetes.
Results:
The full implementation of the new hypertension guidelines would result in approximately 56,000 fewer CV events and 13,000 fewer deaths from CV causes annually, which would result in overall cost savings. The projections showed that the treatment of patients with existing CVD or stage 2 hypertension would save lives and costs for men between the ages of 35 and 74 years, and for women between the ages of 45 and 74 years. The treatment of men or women with existing CVD or men with stage 2 hypertension, but without CVD would remain cost-saving even if strategies to increase medication adherence doubled treatment costs. The treatment of stage 1 hypertension was cost-effective (defined as <$50,000 per QALY) for all men and for women between the ages of 45 and 74 years, whereas treating women between the ages of 35 and 44 years with stage 1 hypertension, but without CVD had intermediate or low cost-effectiveness.
Conclusions:
The implementation of the 2014 hypertension guidelines for US adults between the ages of 35 and 74 years could potentially prevent approximately 56,000 cardiovascular events and 13,000 deaths annually, while saving costs. Controlling hypertension in all patients with CVD or stage 2 hypertension could be effective and cost-saving.
Perspective:
In the United States, more deaths from cardiovascular causes are attributed to elevated blood pressure than to any other risk factor. Mean blood pressure has dropped by a modest 10% since 1960, reflecting the awareness of the risk. The number of persons with hypertension is increasing, and an estimated 44% of the 64 million US adults with hypertension did not have it controlled in 2014. There is an enormous potential for improving population health by expanding treatment and improving control.
Keywords: Blood Pressure, Hypertension, Cost Savings, Cost-Benefit Analysis, Medication Adherence, Quality-Adjusted Life Years, Risk Factors
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