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Treating Mild Chronic Hypertension During Pregnancy: A Cost-Effectiveness Analysis
Uma Doshi1, Sarina Chaiken, Alyssa Hersh
1Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon.
Obstetrics and Gynecology
|February 22, 2024
Summary
Treating chronic hypertension in pregnancy at milder blood pressure targets (140/90 mm Hg) is a cost-effective strategy. This approach reduces maternal and neonatal complications and deaths, while also lowering healthcare costs.
Area of Science:
- Obstetrics and Gynecology
- Cardiology
- Health Economics
Background:
- Chronic hypertension in pregnancy poses significant risks to both mother and fetus.
- Current treatment guidelines vary, with some advocating for higher blood pressure thresholds before intervention.
Purpose of the Study:
- To evaluate the cost-effectiveness of a lower blood pressure target (less than 140/90 mm Hg) versus a higher target (160/105 mm Hg) for managing chronic hypertension in pregnancy.
Main Methods:
- A decision-analytic model simulated outcomes for 180,000 pregnant individuals with chronic hypertension.
- Data on probabilities, costs, and quality-adjusted life-years (QALYs) were literature-derived and analyzed via sensitivity analyses.
- Key outcomes included preeclampsia, severe maternal morbidity, preterm birth, maternal/neonatal deaths, and neurodevelopmental delay.
Main Results:
- Targeting lower blood pressures significantly reduced preeclampsia (14,177 fewer cases) and severe maternal morbidity (817 fewer cases).
- This strategy also decreased maternal deaths (18 fewer), preterm births (8,078 fewer), and neonatal deaths (26 fewer).
- The lower threshold approach was a dominant strategy, saving $600 million and increasing QALYs by 12,852.
Conclusions:
- Treating chronic hypertension in pregnancy at a threshold of 140/90 mm Hg is a dominant and cost-effective strategy.
- This approach leads to improved maternal and neonatal outcomes, including reduced mortality, compared to treating at higher blood pressure ranges.
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