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The Cost Implications of Less Tight Versus Tight Control of Hypertension in Pregnancy (CHIPS Trial)
Rashid J Ahmed1, Amiram Gafni1, Eileen K Hutton1
1From the Department of Obstetrics and Gynecology (R.J.A., E.K.H.), Department of Clinical Epidemiology and Biostatistics, Centre for Health Economics and Policy Analysis (A.G.), and Department of Mathematics and Statistics (Z.J.H.), McMaster University, Hamilton, Ontario, Canada; Biostatistics Division, Dalla Lana School of Public Health, University of Toronto, Hospital for Sick Children, Ontario, Canada (E.P.); Department of Obstetrics and Gynaecology, St. George's University of London, United Kingdom (P.v.D.); Departments of Medicine (E.R.) and Obstetrics and Gynaecology (E.R.), University of Montreal, Quebec, Canada; Department of Obstetrics and Gynaecology, University of Alberta, Edmonton, Canada (S.R.); Departments of Paediatrics (E.A.) and Obstetrics and Gynecology (E.A.), University of Toronto, Sunnybrook Health Sciences Centre, Ontario, Canada; Departments of Obstetrics and Gynecology (K.E.M.) and Medicine (K.E.M., A.G.L.), University of Toronto, Mount Sinai Hospital, Ontario, Canada; Department of Obstetrics and Gynaecology (J.M.), Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute (T.L.), and School of Population and Public Health (J.S.), University of British Columbia, Vancouver, Canada; Clinical Trial Services, The Centre for Mother, Infant and Child Research, Sunnybrook Research Institute, Toronto, Ontario, Canada (J.J.S.); Department of Obstetrics and Gynecology, Academic Medical Centre, Amsterdam, The Netherlands (W.G.); Department of Obstetrics, Gynecology, and Reproductive Sciences, Women's Health, University of Manitoba, Winnipeg, Canada (M.H.); Division of Neonatology, Department of Paediatrics, University of Toronto, The Hospital for Sick Children, Ontario, Canada (S.K.L.); Department of Obstetrics and Gynecology, Université de Sherbrooke, Québec, Canada (J.-M.M.); Department of Obstetrics and Gynaecology, University of Nottingham, Nottingham City Hospital, United Kingdom (J.G.T.); Department of Obstetr
Insights
Tight blood pressure control in pregnancy is as safe as less tight control and may be more cost-effective for the healthcare system. This finding comes from the CHIPS trial cost analysis.
Area of Science:
- Obstetrics and Gynecology
- Cardiovascular Health in Pregnancy
- Health Economics
Background:
- The Control of Hypertension in Pregnancy Study (CHIPS) trial evaluated two blood pressure management strategies for pregnant women.
- No significant differences were found in perinatal or maternal outcomes between less tight and tight blood pressure control.
Purpose of the Study:
- To determine the cost-effectiveness of 'less tight' versus 'tight' blood pressure management from a third-party payer perspective.
- To analyze healthcare resource utilization and costs associated with different hypertension management strategies during pregnancy.
Main Methods:
- A cost-sensitivity analysis was conducted using data from 981 women in the CHIPS trial across 94 centers in 15 countries.
- Costs were evaluated from the perspective of Canadian provincial healthcare systems, utilizing data on hospital ward and health service utilization.
- Statistical analysis compared the mean total cost per woman-infant dyad between the two management strategies.
Main Results:
- The mean total cost per woman-infant dyad was higher in the 'less tight' control group compared to the 'tight' control group in all analyzed Canadian provinces.
- These cost differences were not statistically significant in Ontario, British Columbia, or Alberta.
- The cost per woman-infant dyad was higher in the less tight control group, with differences ranging from $5723 to $6000.23 across provinces.
Conclusions:
- Tight blood pressure management in pregnancy, as demonstrated in the CHIPS trial, may offer benefits to women without increasing neonatal risk.
- This strategy appears to be associated with similar or potentially lower healthcare system costs compared to less tight control.
- Tight control represents a potentially cost-effective approach for managing hypertension in pregnancy.
Unlabelled:
The CHIPS randomized controlled trial (Control of Hypertension in Pregnancy Study) found no difference in the primary perinatal or secondary maternal outcomes between planned "less tight" (target diastolic 100 mm Hg) and "tight" (target diastolic 85 mm Hg) blood pressure management strategies among women with chronic or gestational hypertension. This study examined which of these management strategies is more or less costly from a third-party payer perspective. A total of 981 women with singleton pregnancies and nonsevere, nonproteinuric chronic or gestational hypertension were randomized at 14 to 33 weeks to less tight or tight control. Resources used were collected from 94 centers in 15 countries and costed as if the trial took place in each of 3 Canadian provinces as a cost-sensitivity analysis. Eleven hospital ward and 24 health service costs were obtained from a similar trial and provincial government health insurance schedules of medical benefits. The mean total cost per woman-infant dyad was higher in less tight versus tight control, but the difference in mean total cost (DM) was not statistically significant in any province: Ontario ($30 191.62 versus $24 469.06; DM $5723, 95% confidence interval, -$296 to $12 272; P=0.0725); British Columbia ($30 593.69 versus $24 776.51; DM $5817; 95% confidence interval, -$385 to $12 349; P=0.0725); or Alberta ($31 510.72 versus $25 510.49; DM $6000.23; 95% confidence interval, -$154 to $12 781; P=0.0637). Tight control may benefit women without increasing risk to neonates (as shown in the main CHIPS trial), without additional (and possibly lower) cost to the healthcare system.
Clinical Trial Registration:
URL: http://www.clinicaltrials.gov. Unique identifier: NCT01192412.
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