Cost-Effectiveness of Intensive versus Standard Blood-Pressure Control

Background In the Systolic Blood Pressure Intervention Trial (SPRINT), adults at high risk for cardiovascular disease who received intensive systolic blood-pressure control (target, <120 mm Hg) had significantly lower rates of death and cardiovascular disease events than did those who received standard control (target, <140 mm Hg). On the basis of these data, we wanted to determine the lifetime health benefits and health care costs associated with intensive control versus standard control. Methods We used a microsimulation model to apply SPRINT treatment effects and health care costs from national sources to a hypothetical cohort of SPRINT-eligible adults. The model projected lifetime costs of treatment and monitoring in patients with hypertension, cardiovascular disease events and subsequent treatment costs, treatment-related risks of serious adverse events and subsequent costs, and quality-adjusted life-years (QALYs) for intensive control versus standard control of systolic blood pressure. Results We determined 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. Most simulation results indicated that 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. Conclusions In this simulation study, 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. (Funded by the National Heart, Lung, and Blood Institute and others; SPRINT ClinicalTrials.gov number, NCT01206062.).

Medienart:

Artikel

Erscheinungsjahr:

2017

Erschienen:

2017

Enthalten in:

Zur Gesamtaufnahme - volume:377

Enthalten in:

The New England journal of medicine - 377(2017), 8, Seite 745

Sprache:

Englisch

Beteiligte Personen:

Adam P Bress [VerfasserIn]
Brandon K Bellows [Sonstige Person]
Jordan B King [Sonstige Person]
Rachel Hess [Sonstige Person]
Srinivasan Beddhu [Sonstige Person]
Zugui Zhang [Sonstige Person]
Dan R Berlowitz [Sonstige Person]
Molly B Conroy [Sonstige Person]
Larry Fine [Sonstige Person]
Suzanne Oparil [Sonstige Person]
Donald E Morisky [Sonstige Person]
Lewis E Kazis [Sonstige Person]
Natalia Ruiz-Negrón [Sonstige Person]
Jamie Powell [Sonstige Person]
Leonardo Tamariz [Sonstige Person]
Jeff Whittle [Sonstige Person]
Jackson T Wright Jr [Sonstige Person]
Mark A Supiano [Sonstige Person]
Alfred K Cheung [Sonstige Person]
William S Weintraub [Sonstige Person]
Andrew E Moran [Sonstige Person]

Links:

search.proquest.com

BKL:

44.60

44.00

Themen:

Acute coronary syndromes
Blood pressure
Cardiovascular disease
Cardiovascular diseases
Cardiovascular system
Cost analysis
Estimates
Health care expenditures
Health care policy
Heart attacks
Heart failure
Hypertension
Medicine
Public health

RVK:

RVK Klassifikation

Förderinstitution / Projekttitel:

PPN (Katalog-ID):

OLC1998015548