title: Screening and Treatment for Subclinical Hypertensive Heart Disease in Emergency Department Patients With Uncontrolled Blood Pressure: A Cost-effectiveness Analysis.
abstract: Poorly controlled hypertension (HTN) is extremely prevalent and, if left unchecked, subclinical hypertensive heart disease (SHHD) may ensue leading to conditions such as heart failure. To address this, we designed a multidisciplinary program to detect and treat SHHD in a high-risk, predominantly African American community. The primary objective of this study was to determine the cost-effectiveness of our program.
  
  
  
  Study costs associated with identifying and treating patients with SHHD were calculated and a sensitivity analysis was performed comparing the effect of four parameters on cost estimates. These included prevalence of disease, effectiveness of treatment (regression of SHHD, reversal of left ventricular hypertrophy [LVH], or blood pressure [BP] control as separate measures), echocardiogram costs, and participant time/travel costs. The parent study for this analysis was a single-center, randomized controlled trial comparing cardiac effects of standard and intense (<120/80 mm Hg) BP goals at 1 year in patients with uncontrolled HTN and SHHD. A total of 149 patients (94% African American) were enrolled, 133 (89%) had SHHD, 123 (93%) of whom were randomized, with 88 (72%) completing the study. Patients were clinically evaluated and medically managed over the course of 1 year with repeated echocardiograms. Costs of these interventions were analyzed and, following standard practices, a cost per quality-adjusted life-year (QALY) less than $50,000 was defined as cost-effective.
  
  
  
  Total costs estimates for the program ranged from $117,044 to $119,319. Cost per QALY was dependent on SHHD prevalence and the measure of effectiveness but not input costs. Cost-effectiveness (cost per QALY less than $50,000) was achieved when SHHD prevalence exceeded 11.1% for regression of SHHD, 4.7% for reversal of LVH, and 2.9% for achievement of BP control.
  
  
  
  In this cohort of predominantly African American patients with uncontrolled HTN, SHHD prevalence was high and screening with treatment was cost-effective across a range of assumptions. These data suggest that multidisciplinary programs such as this can be a cost-effective mechanism to mitigate the cardiovascular consequences of HTN in emergency department patients with uncontrolled BP.
authors: Department of Emergency Medicine, Wayne State University, Detroit, MI.
authors: Michael J
authors: MJ
authors: Twiner
authors: Department Surgery, Sinai Grace Hospital, Detroit, MI.
authors: Alexander L
authors: AL
authors: Marinica
authors: Department of Emergency Medicine, St. John Hospital, Detroit, MI.
authors: Kenneth
authors: K
authors: Kuper
authors: Department of Economics, Wayne State University, Detroit, MI.
authors: Allen
authors: A
authors: Goodman
authors: School of Medicine, Wayne State University, Detroit, MI.
authors: James J
authors: JJ
authors: Mahn
authors: Department of Emergency Medicine, Wayne State University, Detroit, MI.
authors: Michael J
authors: MJ
authors: Burla
authors: Department of Emergency Medicine, Wayne State University, Detroit, MI.
authors: Aaron M
authors: AM
authors: Brody
authors: School of Medicine, Wayne State University, Detroit, MI.
authors: Justin A
authors: JA
authors: Carroll
authors: Community Health & Preventive Medicine, Morehouse School of Medicine, Atlanta, GA.
authors: Robina
authors: R
authors: Josiah Willock
authors: Division of Transitional Research and Clinical Epidemiology and Department of Medicine, Wayne State University, Detroit, MI.|Cardiovascular Research Institute, Wayne State University, Detroit, MI.
authors: John M
authors: JM
authors: Flack
authors: College of Education, Health, and Human Services, University of Michigan-Dearborn, Dearborn, MI.
authors: Samar A
authors: SA
authors: Nasser
authors: Cardiovascular Research Institute, Wayne State University, Detroit, MI.
authors: Phillip D
authors: PD
authors: Levy
mesh_terms: D001741:Black or African American; D000368:Aged; D001794:Blood Pressure; D001795:Blood Pressure Determination / Q000191:economics*; D003362:Cost-Benefit Analysis; D004636:Emergency Service, Hospital / Q000191:economics*; D005260:Female; D006331:Heart Diseases / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D019057:Quality-Adjusted Life Years