title: Cost-effectiveness analysis of different systolic blood pressure targets for people with a history of stroke or transient ischaemic attack: Economic analysis of the PAST-BP study.
abstract: The PAST-BP trial found that using a lower systolic blood pressure target (<130 mmHg or lower versus <140 mmHg) in a primary care population with prevalent cerebrovascular disease was associated with a small additional reduction in blood pressure (2.9 mmHg).
  
  
  
  To determine the cost effectiveness of an intensive systolic blood pressure target (<130 mmHg or lower) compared with a standard target (<140 mmHg) in people with a history of stroke or transient ischaemic attack on general practice stroke/transient ischaemic attack registers in England.
  
  
  
  A Markov model with a one-year time cycle and a 30-year time horizon was used to estimate the cost per quality-adjusted life year of an intensive target versus a standard target. Individual patient level data were used from the PAST-BP trial with regard to change in blood pressure and numbers of primary care consultations over a 12-month period. Published sources were used to estimate life expectancy and risks of cardiovascular events and their associated costs and utilities.
  
  
  
  In the base-case results, aiming for an intensive blood pressure target was dominant, with the incremental lifetime costs being £169 lower per patient than for the standard blood pressure target with a 0.08 quality-adjusted life year gain. This was robust to sensitivity analyses, unless intensive blood pressure lowering reduced quality of life by 2% or more.
  
  
  
  Aiming for a systolic blood pressure target of <130 mmHg or lower is cost effective in people who have had a stroke/transient ischaemic attack in the community, but it is difficult to separate out the impact of the lower target from the impact of more active management of blood pressure.
authors.affiliation: Health Economics Unit, University of Birmingham, UK.
authors.forename: Maria Cristina
authors.initials: MC
authors.lastname: Penaloza-Ramos
authors.affiliation: Health Economics Unit, University of Birmingham, UK s.jowett@bham.ac.uk.
authors.forename: Sue
authors.initials: S
authors.lastname: Jowett
authors.affiliation: Health Economics Unit, University of Birmingham, UK.
authors.forename: Pelham
authors.initials: P
authors.lastname: Barton
authors.affiliation: Primary Care Clinical Sciences, University of Birmingham, UK.
authors.forename: Andrea
authors.initials: A
authors.lastname: Roalfe
authors.affiliation: Primary Care Clinical Sciences, University of Birmingham, UK.
authors.forename: Kate
authors.initials: K
authors.lastname: Fletcher
authors.affiliation: Nuffield Department of Primary Health Care Sciences, University of Oxford, UK.
authors.forename: Clare J
authors.initials: CJ
authors.lastname: Taylor
authors.affiliation: Nuffield Department of Primary Health Care Sciences, University of Oxford, UK.
authors.forename: Fd Richard
authors.initials: FR
authors.lastname: Hobbs
authors.affiliation: Nuffield Department of Primary Health Care Sciences, University of Oxford, UK.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: McManus
authors.affiliation: Primary Care Unit, University of Cambridge, UK.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Mant
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects* / Q000502:physiology; D003365:Costs and Cost Analysis; D003661:Decision Support Techniques; D004739:England / Q000453:epidemiology; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D015994:Incidence; D002546:Ischemic Attack, Transient / Q000191:economics / Q000453:epidemiology* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D018803:Models, Economic; D011320:Primary Health Care / Q000191:economics*; D011379:Prognosis; D019057:Quality-Adjusted Life Years; D020521:Stroke / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D015996:Survival Rate / Q000639:trends
chemical_list: D000959:Antihypertensive Agents
keywords: Hypertension; blood pressure target; cost effectiveness; decision analysis; decision model; stroke; transient ischaemic attack