title: Cost-effectiveness of Intensive Blood Pressure Management.
abstract: Among high-risk patients with hypertension, targeting a systolic blood pressure of 120 mm Hg reduces cardiovascular morbidity and mortality compared with a higher target. However, intensive blood pressure management incurs additional costs from treatment and from adverse events.
  
  
  
  To evaluate the incremental cost-effectiveness of intensive blood pressure management compared with standard management.
  
  
  
  This cost-effectiveness analysis conducted from September 2015 to August 2016 used a Markov cohort model to estimate cost-effectiveness of intensive blood pressure management among 68-year-old high-risk adults with hypertension but not diabetes. We used the Systolic Blood Pressure Intervention Trial (SPRINT) to estimate treatment effects and adverse event rates. We used Centers for Disease Control and Prevention Life Tables to project age- and cause-specific mortality, calibrated to rates reported in SPRINT. We also used population-based observational data to model development of heart failure, myocardial infarction, stroke, and subsequent mortality. Costs were based on published sources, Medicare data, and the National Inpatient Sample.
  
  
  
  Treatment of hypertension to a systolic blood pressure goal of 120 mm Hg (intensive management) or 140 mm Hg (standard management).
  
  
  
  Lifetime costs and quality-adjusted life-years (QALYs), discounted at 3% annually.
  
  
  
  Standard management yielded 9.6 QALYs and accrued $155 261 in lifetime costs, while intensive management yielded 10.5 QALYs and accrued $176 584 in costs. Intensive blood pressure management cost $23 777 per QALY gained. In a sensitivity analysis, serious adverse events would need to occur at 3 times the rate observed in SPRINT and be 3 times more common in the intensive management arm to prefer standard management.
  
  
  
  Intensive blood pressure management is cost-effective at typical thresholds for value in health care and remains so even with substantially higher adverse event rates.
authors.affiliation: Palo Alto VA Health Care System, Palo Alto, California2Center for Primary Care and Outcomes Research/Center for Health Policy, Department of Medicine, Stanford University School of Medicine, Stanford, California.
authors.forename: Ilana B
authors.initials: IB
authors.lastname: Richman
authors.affiliation: Department of Management Science and Engineering, Stanford University, Stanford, California.
authors.forename: Michael
authors.initials: M
authors.lastname: Fairley
authors.affiliation: The Cardiovascular Research Center, Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark5Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California.
authors.forename: Mads Emil
authors.initials: ME
authors.lastname: Jørgensen
authors.affiliation: Center for Biomedical Informatics Research, Stanford University, Stanford, California.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Schuler
authors.affiliation: Palo Alto VA Health Care System, Palo Alto, California2Center for Primary Care and Outcomes Research/Center for Health Policy, Department of Medicine, Stanford University School of Medicine, Stanford, California.
authors.forename: Douglas K
authors.initials: DK
authors.lastname: Owens
authors.affiliation: Center for Primary Care and Outcomes Research/Center for Health Policy, Department of Medicine, Stanford University School of Medicine, Stanford, California.
authors.forename: Jeremy D
authors.initials: JD
authors.lastname: Goldhaber-Fiebert
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000191:economics / Q000627:therapeutic use*; D001794:Blood Pressure; D002318:Cardiovascular Diseases / Q000191:economics; D003362:Cost-Benefit Analysis; D017048:Health Care Costs; D006333:Heart Failure; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy* / Q000191:economics; D019057:Quality-Adjusted Life Years
chemical_list: D000959:Antihypertensive Agents