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Antihypertensive therapy: how to evaluate the benefits
1Istituto di Clinico Medico e Terapia Medica, University of Milan, Ospedale Maggiore, Italy.
Insights
Antihypertensive therapy offers significant benefits beyond cardiovascular events, including preventing heart failure and hypertrophy. The actuarial approach reveals a lower cost-effectiveness for life-years gained compared to randomized trials.
Area of Science:
- Cardiovascular Medicine
- Health Economics
- Public Health Policy
Background:
- Antihypertensive therapy benefits are traditionally assessed via randomized trials focusing on cardiovascular events.
- Broader benefits include preventing congestive heart failure, left ventricular hypertrophy, and hypertension progression.
- Quantifying these benefits for cost-effectiveness analysis presents challenges.
Purpose of the Study:
- To evaluate the cost-effectiveness of antihypertensive therapy.
- To compare the traditional randomized trial approach with an actuarial approach for assessing treatment benefits.
- To inform healthcare decision-makers on optimizing antihypertensive treatment strategies.
Main Methods:
- Review of randomized trials monitoring cardiovascular events.
- Application of an actuarial approach using life expectancy data associated with blood pressure reduction.
- Comparative analysis of cost-effectiveness between the two methodologies.
Main Results:
- Randomized trials may underestimate long-term treatment benefits due to limited duration.
- The actuarial approach demonstrates a significantly lower cost per year of life gained from antihypertensive therapy.
- Limiting treatment decisions solely on absolute risk may exclude eligible patients.
Conclusions:
- Both randomized trial and actuarial approaches are crucial for comprehensive cost-effectiveness evaluation of antihypertensive therapy.
- Physicians, patients, and policymakers should consider both methodologies for informed treatment decisions.
- A broader perspective on benefits enhances the value of antihypertensive interventions.
Abstract:
For more than 30 years, the benefits of antihypertensive therapy have been assessed in randomized trials that monitor cardiovascular events. Even greater benefits can result if prevention of (1) congestive heart failure, (2) left ventricular hypertrophy, and (3) progression to more severe hypertension is taken into consideration. However, quantifying the benefits in order to calculate the cost-effectiveness of treatment is not easy. Taking absolute risk and benefit as the only guide to treatment decisions may result in limiting therapy only to elderly hypertensive patients and hypertensive patients with complications. Furthermore, randomized trials, of which the duration is necessarily short, are likely to underestimate treatment benefits. An alternative to such an approach is the actuarial approach: 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 calculated in this way is much lower than the cost calculated from randomized trials. In an uncertain area such as that of cost-effectiveness evaluation, it is important that both approaches are taken into consideration by physicians, patients, politicians, and officers of national health systems.