Alternative Strategies to Achieve Cardiovascular Mortality Goals in China and India: A Microsimulation of Target-...

Area of Science:

• Public Health
• Cardiovascular Disease Research
• Health Economics

Background:

• The World Health Organization (WHO) targets a 25% reduction in chronic disease mortality by 2025.
• High blood pressure (hypertension) is a primary risk factor for cardiovascular disease (CVD).
• Comparing blood pressure management strategies is crucial for public health initiatives.

Purpose of the Study:

• To compare the effectiveness and cost-effectiveness of three blood pressure management strategies in China and India.
• To evaluate a benefit-based tailored treatment (BTT) strategy against treat-to-target (TTT) and WHO hybrid strategies.
• To inform policy decisions for CVD risk reduction.

Main Methods:

• Development of a microsimulation model for adults aged 30-70 in China and India.
• Comparison of BTT (≥10% 10-year CVD risk) with TTT and WHO hybrid strategies over a 10-year horizon.
• Analysis of cost-effectiveness in terms of disability-adjusted life-years (DALYs) averted.

Main Results:

• The BTT strategy averted approximately 5 million more DALYs in China and India compared to the TTT approach.
• BTT demonstrated superior cost-effectiveness, with costs ranging from $205 to $272 per DALY averted.
• The hybrid strategy offered no substantial benefits over the TTT approach.
• BTT's effectiveness remained robust across various sensitivity analyses, including risk estimation, age ranges, and treatment adherence.

Conclusions:

• A simplified benefit-based tailored treatment (BTT) strategy is more effective and cost-effective for reducing mortality.
• BTT offers a significant advantage over traditional treat-to-target and WHO hybrid strategies.
• These findings support the adoption of BTT for hypertension management to improve population health outcomes and reduce healthcare costs.