title: Comparative Cost-Effectiveness of Hypertension Treatment in Non-Hispanic Blacks and Whites According to 2014 Guidelines: A Modeling Study.
abstract: We compared the cost-effectiveness of hypertension treatment in non-Hispanic blacks and non-Hispanic whites according to 2014 US hypertension treatment guidelines.
  
  
  
  The cardiovascular disease (CVD) policy model simulated CVD events, quality-adjusted life years (QALYs), and treatment costs in 35- to 74-year-old adults with untreated hypertension. CVD incidence, mortality, and risk factor levels were obtained from cohort studies, hospital registries, vital statistics, and national surveys. Stage 1 hypertension was defined as blood pressure 140-149/90-99mm Hg; stage 2 hypertension as ≥150/100mm Hg. Probabilistic input distribution sampling informed 95% uncertainty intervals (UIs). Incremental cost-effectiveness ratios (ICERs) < $50,000/QALY gained were considered cost-effective.
  
  
  
  Treating 0.7 million hypertensive non-Hispanic black adults would prevent about 8,000 CVD events annually; treating 3.4 million non-Hispanic whites would prevent about 35,000 events. Overall 2014 guideline implementation would be cost saving in both groups compared with no treatment. For stage 1 hypertension but without diabetes or chronic kidney disease, cost savings extended to non-Hispanic black males ages 35-44 but not same-aged non-Hispanic white males (ICER $57,000/QALY; 95% UI $15,000-$100,000) and cost-effectiveness extended to non-Hispanic black females ages 35-44 (ICER $46,000/QALY; $17,000-$76,000) but not same-aged non-Hispanic white females (ICER $181,000/QALY; $111,000-$235,000).
  
  
  
  Compared with non-Hispanic whites, cost-effectiveness of implementing hypertension guidelines would extend to a larger proportion of non-Hispanic black hypertensive patients.
authors.affiliation: College of Physicians and Surgeons, Columbia University, New York, USA;
authors.forename: Eshan
authors.initials: E
authors.lastname: Vasudeva
authors.affiliation: Department of General Medicine, Columbia University Medical Center, New York, USA;
authors.forename: Nathalie
authors.initials: N
authors.lastname: Moise
authors.affiliation: Department of Evidence Based Medicine, Cardiovascular Institute and Fu Wai Hospital of the Chinese Academy of Medical Sciences, Beijing, China; National Center for Cardiovascular Diseases, Beijing, China;
authors.forename: Chen
authors.initials: C
authors.lastname: Huang
authors.affiliation: Department of Medicine, University of California at San Francisco, San Francisco, California, USA.
authors.forename: Antoinette
authors.initials: A
authors.lastname: Mason
authors.affiliation: Department of Medicine, University of California at San Francisco, San Francisco, California, USA.
authors.forename: Joanne
authors.initials: J
authors.lastname: Penko
authors.affiliation: College of Physicians and Surgeons, Columbia University, New York, USA;
authors.forename: Lee
authors.initials: L
authors.lastname: Goldman
authors.affiliation: Department of Medicine, University of California at San Francisco, San Francisco, California, USA.
authors.forename: Pamela G
authors.initials: PG
authors.lastname: Coxson
authors.affiliation: Department of Medicine, University of California at San Francisco, San Francisco, California, USA.
authors.forename: Kirsten
authors.initials: K
authors.lastname: Bibbins-Domingo
authors.affiliation: College of Physicians and Surgeons, Columbia University, New York, USA; Department of General Medicine, Columbia University Medical Center, New York, USA; aem35@cumc.columbia.edu.
authors.forename: Andrew E
authors.initials: AE
authors.lastname: Moran
mesh_terms: D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000191:economics* / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000191:economics*; D008297:Male; D008875:Middle Aged; D018803:Models, Economic; D017410:Practice Guidelines as Topic
chemical_list: D000959:Antihypertensive Agents
keywords: blood pressure; cost-effectiveness; hypertension; race.