title: Comparative Cost-Effectiveness of Conservative or Intensive Blood Pressure Treatment Guidelines in Adults Aged 35-74 Years: The Cardiovascular Disease Policy Model.
abstract: The population health effect and cost-effectiveness of implementing intensive blood pressure goals in high-cardiovascular disease (CVD) risk adults have not been described. Using the CVD Policy Model, CVD events, treatment costs, quality-adjusted life years, and drug and monitoring costs were simulated over 2016 to 2026 for hypertensive patients aged 35 to 74 years. We projected the effectiveness and costs of hypertension treatment according to the 2003 Joint National Committee (JNC)-7 or 2014 JNC8 guidelines, and then for adults aged ≥50 years, we assessed the cost-effectiveness of adding an intensive goal of systolic blood pressure <120 mm Hg for patients with CVD, chronic kidney disease, or 10-year CVD risk ≥15%. Incremental cost-effectiveness ratios <$50 000 per quality-adjusted life years gained were considered cost-effective. JNC7 strategies treat more patients and are more costly to implement compared with JNC8 strategies. Adding intensive systolic blood pressure goals for high-risk patients prevents an estimated 43 000 and 35 000 annual CVD events incremental to JNC8 and JNC7, respectively. Intensive strategies save costs in men and are cost-effective in women compared with JNC8 alone. At a willingness-to-pay threshold of $50 000 per quality-adjusted life years gained, JNC8+intensive had the highest probability of cost-effectiveness in women (82%) and JNC7+intensive the highest probability of cost-effectiveness in men (100%). Assuming higher drug and monitoring costs, adding intensive goals for high-risk patients remained consistently cost-effective in men, but not always in women. Among patients aged 35 to 74 years, adding intensive blood pressure goals for high-risk groups to current national hypertension treatment guidelines prevents additional CVD deaths while saving costs provided that medication costs are controlled.
authors.affiliation: From the Division of General Medicine, Department of Medicine, Columbia University Medical Center, New York, NY (N.M., C.N.K.-L., K.Y.T., A.E.M.); Department of Evidence Based Medicine, Cardiovascular Institute and Fu Wai Hospital of the Chinese Academy of Medical Sciences, Beijing, China (C.H.); Department of Epidemiology, Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medicine Science, Beijing, China (C.H.); George Institute for Global Health, Sydney, New South Wales, Australia (A.R.); Health Economics & Health Technology Assessment, Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences and College of Social Sciences, University of Glasgow, Glasgow, United Kingdom (C.N.K.-L.); Division of General Medicine, Department of Medicine, University of California at San Francisco (P.G.C., K.B.-D); and College of Physicians and Surgeons, Columbia University, New York, NY (L.G., A.E.M.).
authors.forename: Nathalie
authors.initials: N
authors.lastname: Moise
authors.affiliation: From the Division of General Medicine, Department of Medicine, Columbia University Medical Center, New York, NY (N.M., C.N.K.-L., K.Y.T., A.E.M.); Department of Evidence Based Medicine, Cardiovascular Institute and Fu Wai Hospital of the Chinese Academy of Medical Sciences, Beijing, China (C.H.); Department of Epidemiology, Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medicine Science, Beijing, China (C.H.); George Institute for Global Health, Sydney, New South Wales, Australia (A.R.); Health Economics & Health Technology Assessment, Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences and College of Social Sciences, University of Glasgow, Glasgow, United Kingdom (C.N.K.-L.); Division of General Medicine, Department of Medicine, University of California at San Francisco (P.G.C., K.B.-D); and College of Physicians and Surgeons, Columbia University, New York, NY (L.G., A.E.M.).
authors.forename: Chen
authors.initials: C
authors.lastname: Huang
authors.affiliation: From the Division of General Medicine, Department of Medicine, Columbia University Medical Center, New York, NY (N.M., C.N.K.-L., K.Y.T., A.E.M.); Department of Evidence Based Medicine, Cardiovascular Institute and Fu Wai Hospital of the Chinese Academy of Medical Sciences, Beijing, China (C.H.); Department of Epidemiology, Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medicine Science, Beijing, China (C.H.); George Institute for Global Health, Sydney, New South Wales, Australia (A.R.); Health Economics & Health Technology Assessment, Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences and College of Social Sciences, University of Glasgow, Glasgow, United Kingdom (C.N.K.-L.); Division of General Medicine, Department of Medicine, University of California at San Francisco (P.G.C., K.B.-D); and College of Physicians and Surgeons, Columbia University, New York, NY (L.G., A.E.M.).
authors.forename: Anthony
authors.initials: A
authors.lastname: Rodgers
authors.affiliation: From the Division of General Medicine, Department of Medicine, Columbia University Medical Center, New York, NY (N.M., C.N.K.-L., K.Y.T., A.E.M.); Department of Evidence Based Medicine, Cardiovascular Institute and Fu Wai Hospital of the Chinese Academy of Medical Sciences, Beijing, China (C.H.); Department of Epidemiology, Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medicine Science, Beijing, China (C.H.); George Institute for Global Health, Sydney, New South Wales, Australia (A.R.); Health Economics & Health Technology Assessment, Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences and College of Social Sciences, University of Glasgow, Glasgow, United Kingdom (C.N.K.-L.); Division of General Medicine, Department of Medicine, University of California at San Francisco (P.G.C., K.B.-D); and College of Physicians and Surgeons, Columbia University, New York, NY (L.G., A.E.M.).
authors.forename: Ciaran N
authors.initials: CN
authors.lastname: Kohli-Lynch
authors.affiliation: From the Division of General Medicine, Department of Medicine, Columbia University Medical Center, New York, NY (N.M., C.N.K.-L., K.Y.T., A.E.M.); Department of Evidence Based Medicine, Cardiovascular Institute and Fu Wai Hospital of the Chinese Academy of Medical Sciences, Beijing, China (C.H.); Department of Epidemiology, Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medicine Science, Beijing, China (C.H.); George Institute for Global Health, Sydney, New South Wales, Australia (A.R.); Health Economics & Health Technology Assessment, Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences and College of Social Sciences, University of Glasgow, Glasgow, United Kingdom (C.N.K.-L.); Division of General Medicine, Department of Medicine, University of California at San Francisco (P.G.C., K.B.-D); and College of Physicians and Surgeons, Columbia University, New York, NY (L.G., A.E.M.).
authors.forename: Keane Y
authors.initials: KY
authors.lastname: Tzong
authors.affiliation: From the Division of General Medicine, Department of Medicine, Columbia University Medical Center, New York, NY (N.M., C.N.K.-L., K.Y.T., A.E.M.); Department of Evidence Based Medicine, Cardiovascular Institute and Fu Wai Hospital of the Chinese Academy of Medical Sciences, Beijing, China (C.H.); Department of Epidemiology, Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medicine Science, Beijing, China (C.H.); George Institute for Global Health, Sydney, New South Wales, Australia (A.R.); Health Economics & Health Technology Assessment, Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences and College of Social Sciences, University of Glasgow, Glasgow, United Kingdom (C.N.K.-L.); Division of General Medicine, Department of Medicine, University of California at San Francisco (P.G.C., K.B.-D); and College of Physicians and Surgeons, Columbia University, New York, NY (L.G., A.E.M.).
authors.forename: Pamela G
authors.initials: PG
authors.lastname: Coxson
authors.affiliation: From the Division of General Medicine, Department of Medicine, Columbia University Medical Center, New York, NY (N.M., C.N.K.-L., K.Y.T., A.E.M.); Department of Evidence Based Medicine, Cardiovascular Institute and Fu Wai Hospital of the Chinese Academy of Medical Sciences, Beijing, China (C.H.); Department of Epidemiology, Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medicine Science, Beijing, China (C.H.); George Institute for Global Health, Sydney, New South Wales, Australia (A.R.); Health Economics & Health Technology Assessment, Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences and College of Social Sciences, University of Glasgow, Glasgow, United Kingdom (C.N.K.-L.); Division of General Medicine, Department of Medicine, University of California at San Francisco (P.G.C., K.B.-D); and College of Physicians and Surgeons, Columbia University, New York, NY (L.G., A.E.M.).
authors.forename: Kirsten
authors.initials: K
authors.lastname: Bibbins-Domingo
authors.affiliation: From the Division of General Medicine, Department of Medicine, Columbia University Medical Center, New York, NY (N.M., C.N.K.-L., K.Y.T., A.E.M.); Department of Evidence Based Medicine, Cardiovascular Institute and Fu Wai Hospital of the Chinese Academy of Medical Sciences, Beijing, China (C.H.); Department of Epidemiology, Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medicine Science, Beijing, China (C.H.); George Institute for Global Health, Sydney, New South Wales, Australia (A.R.); Health Economics & Health Technology Assessment, Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences and College of Social Sciences, University of Glasgow, Glasgow, United Kingdom (C.N.K.-L.); Division of General Medicine, Department of Medicine, University of California at San Francisco (P.G.C., K.B.-D); and College of Physicians and Surgeons, Columbia University, New York, NY (L.G., A.E.M.).
authors.forename: Lee
authors.initials: L
authors.lastname: Goldman
authors.affiliation: From the Division of General Medicine, Department of Medicine, Columbia University Medical Center, New York, NY (N.M., C.N.K.-L., K.Y.T., A.E.M.); Department of Evidence Based Medicine, Cardiovascular Institute and Fu Wai Hospital of the Chinese Academy of Medical Sciences, Beijing, China (C.H.); Department of Epidemiology, Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medicine Science, Beijing, China (C.H.); George Institute for Global Health, Sydney, New South Wales, Australia (A.R.); Health Economics & Health Technology Assessment, Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences and College of Social Sciences, University of Glasgow, Glasgow, United Kingdom (C.N.K.-L.); Division of General Medicine, Department of Medicine, University of California at San Francisco (P.G.C., K.B.-D); and College of Physicians and Surgeons, Columbia University, New York, NY (L.G., A.E.M.). aem35@cumc.columbia.edu.
authors.forename: Andrew E
authors.initials: AE
authors.lastname: Moran
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000959:Antihypertensive Agents / Q000008:administration & dosage / Q000191:economics*; D001795:Blood Pressure Determination; D002318:Cardiovascular Diseases / Q000191:economics / Q000401:mortality / Q000517:prevention & control; D000072700:Conservative Treatment / Q000191:economics* / Q000379:methods; D003362:Cost-Benefit Analysis; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D017048:Health Care Costs; D006291:Health Policy; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics* / Q000401:mortality; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D011050:Policy Making; D017410:Practice Guidelines as Topic; D019057:Quality-Adjusted Life Years; D018570:Risk Assessment; D014481:United States
chemical_list: D000959:Antihypertensive Agents
keywords: cardiovascular diseases; cost-benefit analysis; guideline; hypertension; policy