Effectiveness and cost-effectiveness of blood pressure screening in adolescents in the United States.
OBJECTIVE
To compare the long-term effectiveness and cost-effectiveness of 3 approaches to managing elevated blood pressure (BP) in adolescents in the United States: no intervention, "screen-and-treat," and population-wide strategies to lower the entire BP distribution.


METHODS
We used a simulation model to combine several data sources to project the lifetime costs and cardiovascular outcomes for a cohort of 15-year-old U.S. adolescents under different BP approaches and conducted cost-effectiveness analysis. We obtained BP distributions from the National Health and Nutrition Examination Survey 1999-2004 and used childhood-to-adult longitudinal correlation analyses to simulate the tracking of BP. We then used the coronary heart disease policy model to estimate lifetime coronary heart disease events, costs, and quality-adjusted life years (QALY).


RESULTS
Among screen-and-treat strategies, finding and treating the adolescents at highest risk (eg, left ventricular hypertrophy) was most cost-effective ($18000/QALY [boys] and $47000/QALY [girls]). However, all screen-and-treat strategies were dominated by population-wide strategies such as salt reduction (cost-saving [boys] and $650/QALY [girls]) and increasing physical education ($11000/QALY [boys] and $35000/QALY [girls]).


CONCLUSIONS
Routine adolescents BP screening is moderately effective, but population-based BP interventions with broader reach could potentially be less costly and more effective for early cardiovascular disease prevention and should be implemented in parallel.
Wang
Y Claire
YC
Department of Health Policy and Management, Columbia Mailman School of Public Health, New York, NY, USA.
Cheung
Angela M
AM
Bibbins-Domingo
Kirsten
K
Prosser
Lisa A
LA
Cook
Nancy R
NR
Goldman
Lee
L
Gillman
Matthew W
MW
D000293:Adolescent; D000959:Antihypertensive Agents / Q000009:adverse effects / Q000627:therapeutic use; D001795:Blood Pressure Determination; D015331:Cohort Studies; D003327:Coronary Disease / Q000191:economics / Q000517:prevention & control*; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000191:economics* / Q000453:epidemiology*; D008297:Male; D008390:Markov Chains; D008403:Mass Screening / Q000191:economics* / Q000379:methods; D015397:Program Evaluation; D019057:Quality-Adjusted Life Years; D018570:Risk Assessment; D014481:United States
D000959:Antihypertensive Agents