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Cost-effectiveness analysis of hypertension guidelines in South Africa: absolute risk versus blood pressure level
Thomas A Gaziano1, Krisela Steyn, David J Cohen
1Division of Social Medicine and Health Inequalities, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA. tgaziano@partners.org
Circulation
|December 7, 2005
Summary
Hypertension treatment guidelines in South Africa are more effective and less costly when based on absolute cardiovascular disease (CVD) risk rather than blood pressure levels. This risk-based approach can optimize resource allocation in developing nations.
Area of Science:
- Public Health
- Cardiology
- Health Economics
Background:
- Hypertension is a leading global cardiovascular risk factor.
- Current blood pressure-based guidelines may be cost-prohibitive, particularly in developing countries.
- Absolute cardiovascular disease (CVD) risk assessment offers a potential alternative strategy.
Purpose of the Study:
- To compare the cost-effectiveness of hypertension treatment initiation strategies in South Africa.
- To evaluate guidelines based on blood pressure levels versus absolute CVD risk.
- To inform optimal hypertension management in developing country contexts.
Main Methods:
- A Markov CVD model simulated a hypothetical cohort of South African adults over 10 years.
- Compared six treatment initiation strategies: two blood pressure thresholds and four absolute CVD risk thresholds.
- Assessed incremental cost-effectiveness ratios (ICERs) per quality-adjusted life-year gained.
Main Results:
- Treatment based on absolute CVD risk >15% was more effective and less costly than blood pressure-level-based strategies.
- ICERs for absolute risk thresholds of >40%, 30%, 20%, and 15% were $700, $1600, $4900, and $11,000 per QALY, respectively.
- Sensitivity analyses confirmed the robustness of the strategy ranking.
Conclusions:
- Absolute CVD risk-based guidelines for hypertension treatment are superior to blood pressure-level-based guidelines in South Africa.
- Implementing quantitative risk-based guidelines can redirect significant resources to other health priorities in developing countries.
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