title: Cost-effectiveness of a hypertension management programme in an elderly population: a Markov model.
abstract: BACKGROUND
  Mounting evidence shows that multi-intervention programmes for hypertension treatment are more effective than an isolated pharmacological strategy. Full economic evaluations of hypertension management programmes are scarce and contain methodological limitations. The aim of the study was to evaluate if a hypertension management programme for elderly patients is cost-effective compared to usual care from the perspective of a third-party payer.
  
  
  METHODS
  We built a cost-effectiveness model using published evidence of effectiveness of a comprehensive hypertension programme vs. usual care for patients 65 years or older at a community hospital in Buenos Aires, Argentina. We explored incremental cost-effectiveness between groups. The model used a life-time framework adopting a third-party payer's perspective. Incremental cost-effectiveness ratio (ICER) was calculated in International Dollars per life-year gained. We performed a probabilistic sensitivity analysis (PSA) to explore variable uncertainty.
  
  
  RESULTS
  The ICER for the base-case of the "Hypertension Programme" versus the "Usual care" approach was 1,124 International Dollars per life-year gained. PSA did not significantly influence results. The programme had a probability of 43% of being dominant (more effective and less costly) and, overall, 95% chance of being cost-effective.
  
  
  CONCLUSIONS
  Results showed that "Hypertension Programme" had high probabilities of being cost-effective under a wide range of scenarios. This is the first sound cost-effectiveness study to assess a comprehensive hypertension programme versus usual care. This study measures hard outcomes and explores robustness through a probabilistic sensitivity analysis.
  
  
  CONCLUSIONS
  The comprehensive hypertension programme had high probabilities of being cost-effective versus usual care. This study supports the idea that similar programmes could be the preferred strategy in countries and within health care systems where hypertension treatment for elderly patients is a standard practice.
authors.affiliation: Medical Programmes, Hospital Italiano de Buenos Aires, (Perón 4253, 2°), Ciudad de Buenos Aires, (C1199ABC), Argentina. gaston.perman@hospitalitaliano.org.ar.
authors.forename: Gastón
authors.initials: G
authors.lastname: Perman
authors.forename: Emiliano
authors.initials: E
authors.lastname: Rossi
authors.forename: Gabriel D
authors.initials: GD
authors.lastname: Waisman
authors.forename: Cristina
authors.initials: C
authors.lastname: Agüero
authors.forename: Claudio D
authors.initials: CD
authors.lastname: González
authors.forename: Carlos L
authors.initials: CL
authors.lastname: Pallordet
authors.forename: Silvana
authors.initials: S
authors.lastname: Figar
authors.forename: Fernán
authors.initials: F
authors.lastname: González Bernaldo de Quirós
authors.forename: Joann
authors.initials: J
authors.lastname: Canning
authors.forename: Enrique R
authors.initials: ER
authors.lastname: Soriano