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Cost-effectiveness of hypertension therapy according to 2014 guidelines
Andrew E Moran1, Michelle C Odden, Anusorn Thanataveerat
1From the College of Physicians and Surgeons, Columbia University (A.E.M., L.G.), and Division of General Medicine, Columbia University Medical Center (A.E.M., A.T., K.Y.T., P.W.R.) - both in New York; School of Biological and Population Health Sciences, Oregon State University, Corvallis (M.C.O.); Department of Medicine, University of California, San Francisco (D.G., K.B.-D., P.G.C.); and Partners Health Care, Boston (L.W.).
Insights
Implementing 2014 hypertension guidelines in U.S. adults could prevent 56,000 cardiovascular events and 13,000 deaths annually, saving costs. Treating stage 2 hypertension or hypertension in patients with cardiovascular disease is cost-saving and effective.
Area of Science:
- Cardiovascular Medicine
- Public Health Policy
- Health Economics
Background:
- Many U.S. adults eligible for hypertension therapy remain untreated based on 2014 guidelines.
- There is a need to assess the cost-effectiveness of implementing these guidelines.
Purpose of the Study:
- To project the cost-effectiveness of treating hypertension in U.S. adults according to the 2014 guidelines.
- To evaluate cost-effectiveness across different age groups, hypertension levels, and comorbidities.
Main Methods:
- Utilized the Cardiovascular Disease Policy Model to simulate costs and quality-adjusted life-years (QALYs).
- Modeled drug-treatment, monitoring, and averted cardiovascular disease treatment costs.
- Assessed cost-effectiveness for adults aged 35-74 from 2014-2024, stratified by age, hypertension severity, and presence of chronic kidney disease or diabetes.
Main Results:
- Full guideline implementation could prevent ~56,000 cardiovascular events and 13,000 deaths annually, yielding cost savings.
- Treatment of stage 2 hypertension or hypertension in patients with existing cardiovascular disease is cost-saving for most age groups and sexes.
- Treatment of stage 1 hypertension is cost-effective for most men and women aged 45-74, with lower cost-effectiveness for younger women without cardiovascular disease.
Conclusions:
- Implementing the 2014 hypertension guidelines can prevent significant cardiovascular morbidity and mortality while reducing healthcare costs.
- Controlling hypertension in patients with cardiovascular disease or stage 2 hypertension is a highly effective and cost-saving strategy.
- The findings support the widespread adoption and adherence to the 2014 hypertension management guidelines.
Background:
On the basis of the 2014 guidelines for hypertension therapy in the United States, many eligible adults remain untreated. We projected the cost-effectiveness of treating hypertension in U.S. adults according to the 2014 guidelines.
Methods:
We used the Cardiovascular Disease Policy Model to simulate drug-treatment and monitoring costs, costs averted for the treatment of cardiovascular disease, and quality-adjusted life-years (QALYs) gained by treating previously untreated adults between the ages of 35 and 74 years from 2014 through 2024. We assessed cost-effectiveness 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 cardiovascular events and 13,000 fewer deaths from cardiovascular causes annually, which would result in overall cost savings. The projections showed that the treatment of patients with existing cardiovascular disease 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 cardiovascular disease or men with stage 2 hypertension but without cardiovascular disease 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 cardiovascular disease had intermediate or low cost-effectiveness.
Conclusions:
The implementation of the 2014 hypertension guidelines for U.S. adults between the ages of 35 and 74 years could potentially prevent about 56,000 cardiovascular events and 13,000 deaths annually, while saving costs. Controlling hypertension in all patients with cardiovascular disease or stage 2 hypertension could be effective and cost-saving. (Funded by the National Heart, Lung, and Blood Institute and others.).
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