Related Experiment Videos
[Therapy of arterial hypertension: benefits, costs, challenges]
1Istituto di Clinica Medica Generale e Terapia Medica, Università degli Studi di Milano, IRCCS Ospedale Maggiore, Centro Auxologico Italiano di Milano.
Insights
Antihypertensive therapy offers significant benefits beyond cardiovascular event prevention. The actuarial approach reveals a lower cost-effectiveness for life-years gained compared to randomized trials.
Area of Science:
- Cardiology
- Public Health
- Health Economics
Context:
- Antihypertensive therapy benefits have been assessed via randomized trials for over 30 years.
- Considering congestive heart failure, left ventricular hypertrophy, and hypertension progression reveals greater benefits.
- Quantifying treatment benefits for cost-effectiveness analysis presents challenges.
Purpose:
- To compare the cost-effectiveness of antihypertensive therapy using randomized trial outcomes versus an actuarial approach.
- To highlight the potential underestimation of treatment benefits in short-duration randomized trials.
- To advocate for the consideration of both assessment methods in healthcare decision-making.
Summary:
- Randomized trials primarily measure cardiovascular events, potentially underestimating antihypertensive therapy benefits.
- The actuarial approach, using life expectancy data, offers an alternative cost-effectiveness calculation.
- Actuarial calculations show antihypertensive therapy yields more life-years gained at a lower cost than randomized trial outcome-based calculations.
Impact:
- The actuarial approach suggests antihypertensive therapy is more cost-effective than previously estimated by randomized trials.
- This study encourages a broader consideration of cost-effectiveness methodologies in hypertension management.
- Findings are relevant for physicians, patients, policymakers, and national health system administrators.
Abstract:
For more than 30 years the benefits of antihypertensive therapy have been assessed by randomized trials measuring cardiovascular events. Even greater benefits are found if prevention of congestive heart failure, left ventricular hypertrophy, and progression to more severe hypertension are considered. Quantifying the benefits in order to calculate cost-effectiveness of treatment is not easy, however. Taking absolute risk and absolute benefit as a guide to treatment decision, though an important approach, may result in limiting therapy to elderly and complicated hypertensives only. Furthermore randomized trials, whose duration is necessarily short, are likely to underestimate treatment benefits. An alternative is the actuarial approach, by which treatment benefits are calculated from the actuarial data showing the reduction in life expectancy associated with any given blood pressure increase. The cost of antihypertensive therapy per year of life gained, as calculated by the actuarial approach, is much lower than the cost calculated on the basis of the outcomes of randomized trials. In an uncertain area such as that of cost-effectiveness evaluation, it is important that both approaches be brought to the consideration of physicians, patients, politicians, and officers of national health systems.