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Potential health impact and cost-effectiveness of drug therapy for prehypertension
Tao Chen1, Dahai Yu2, Victoria Cornelius3
1Department of Nephrology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou 450052, China; Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK; Department of Epidemiology and Biostatistics, Nanjing Medical University, Nanjing 210029, China.
Insights
Pharmacologic treatment for prehypertension in Chinese adults without cardiovascular disease (CVD) delays hypertension onset and reduces CVD risk. While potentially cost-effective, its value depends on treatment effects and initiation age.
Area of Science:
- Cardiovascular Medicine
- Health Economics
- Preventive Cardiology
Background:
- Prehypertension poses a risk for future cardiovascular disease (CVD).
- Pharmacologic interventions like candesartan or ramipril may reduce hypertension risk in prehypertensive individuals without clinical CVD.
- The cost-effectiveness and long-term CVD risk reduction of such drug treatments remain unclear.
Purpose of the Study:
- To evaluate the cost-effectiveness and long-term cardiovascular risk reduction of pharmacologic treatment for high-range prehypertension in Chinese adults without CVD.
Main Methods:
- A Markov state-transition model simulated a cohort of Chinese adults with high-range prehypertension (130-139/85-89mmHg) and no CVD.
- Data on CVD and hypertension incidence, utility, and costs were sourced from risk equations and published literature.
- Sensitivity analyses (deterministic and probabilistic) assessed the robustness and uncertainty of the model.
Main Results:
- Drug treatment delayed hypertension by nearly 12 years, reducing its incidence by 32.01% over a lifetime compared to placebo.
- Cumulative incidence of coronary heart disease, stroke, and heart failure decreased, improving survival from 28.46 to 28.80 years.
- The incremental cost-effectiveness ratio was $12,994 per quality-adjusted life-year, sensitive to treatment effect size and initiation age. Cost-effectiveness was probable at a willingness-to-pay threshold exceeding 3x China's 2014 GDP per capita.
Conclusions:
- Pharmacologic treatment for prehypertension in Chinese adults without CVD may mitigate the hypertension epidemic.
- This intervention could potentially reduce CVD complications and prove cost-effective.
- Further research should consider the specific impact of treatment efficacy and patient age on cost-effectiveness.
Background:
Studies have reported that pharmacologic interventions with candesartan or ramipril could reduce the risk of hypertension among prehypertensive subjects free of clinical cardiovascular disease (CVD), however, the cost-effectiveness and long-term cardiovascular risk of drug treatment among these population is unclear.
Method:
A Markov state-transition model was developed to simulate a hypothetical cohort of Chinese adults with high-range prehypertension (130-139/85-89mmHg) but without CVD. Data on the incidence of CVD and hypertension was obtained from corresponding risk equations. Utility and disease-related costs were obtained from published literatures. Robustness and uncertainty was evaluated using deterministic and probabilistic sensitivity analyses.
Results:
Compared with placebo, drug treatment resulted in delaying the development of hypertension by nearly 12years and reducing the absolute incidence of hypertension by 32.01% over lifetime. The cumulative incidence of coronary heart disease, stroke and heart failure were reduced and survival was improved from 28.46 to 28.80years. The average incremental cost effectiveness ratio for drug treatment was $12,994 per quality-adjusted life-year and the value was mostly sensitive to the effect size of treatment and age starting treatment. At a willingness-to-pay threshold of >3×China gross domestic product per capita in 2014, there was a 30.48% chance that drug treatment would remain cost-effective and a low chance of being cost-effective if relative risk of treatment on hypertension was larger than 0.64.
Conclusion:
Drug treatment for prehypertension may help stem the current epidemic of hypertension among Chinese adults free of CVD, which may in turn reduce CVD complications and potentially be cost effective.
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