Year: 2017
Type: article
Abstract: BACKGROUND: In the Systolic Blood Pressure Intervention Trial (SPRINT), adults at high risk for cardiovascular disease who received intensive systolic blood-pressure control (target, <120 mm Hg) had significantly lower rates of death and cardiovascular disease events than did those who received standard control (target, <140 mm Hg). On the basis of these data, we wanted to determine the lifetime health benefits and health care costs associated with intensive control versus standard control. METHODS: We used a microsimulation model to apply SPRINT treatment effects and health care costs from national sources to a hypothetical cohort of SPRINT-eligible adults. The model projected lifetime costs of treatment and monitoring in patients with hypertension, cardiovascular disease events and subsequent treatment costs, treatment-related risks of serious adverse events and subsequent costs, and quality-adjusted life-years (QALYs) for intensive control versus standard control of systolic blood pressure. RESULTS: We determined that the mean number of QALYs would be 0.27 higher among patients who received intensive control than among those who received standard control and would cost approximately $47,000 more per QALY gained if there were a reduction in adherence and treatment effects after 5 years; the cost would be approximately $28,000 more per QALY gained if the treatment effects persisted for the remaining lifetime of the patient. Most simulation results indicated that intensive treatment would be cost-effective (51 to 79% below the willingness-to-pay threshold of $50,000 per QALY and 76 to 93% below the threshold of $100,000 per QALY), regardless of whether treatment effects were reduced after 5 years or persisted for the remaining lifetime. CONCLUSIONS: In this simulation study, intensive systolic blood-pressure control prevented cardiovascular disease events and prolonged life and did so at levels below common willingness-to-pay thresholds per QALY, regardless of whether benefits were reduced after 5 years or persisted for the patient's remaining lifetime. (Funded by the National Heart, Lung, and Blood Institute and others; SPRINT ClinicalTrials.gov number, NCT01206062 .).
Source: New England Journal of Medicine
Authors: Adam P. Bress, Brandon K. Bellows, Jordan B. King, Rachel Hess, Srinivasan Beddhu, Zugui Zhang, Dan R. Berlowitz, Molly B. Conroy, Larry Fine, Suzanne Oparil, Donald E. Morisky, Lewis E. Kazis, Natalia Ruiz-Negrón, Jamie Powell, Leonardo Tamariz, Jeff Whittle, Jackson T. Wright, Mark A. Supiano, Alfred K. Cheung, William S. Weintraub, Andrew E. Moran
Institutions: University of Utah, Veterans Health Administration, VA Salt Lake City Healthcare System, University of Utah Health Care, Kaiser Permanente, Center for Health Optimization and Implementation Research, Christiana Care Health System, Boston University, Milwaukee VA Medical Center, National Heart, Lung, and Blood Institute, University of Alabama at Birmingham, University of California, Los Angeles, East Carolina University, University of Miami, Medical College of Wisconsin, Columbia University Irving Medical Center
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
Funders: U.S. Department of Veterans Affairs, National Institutes of Health, National Institute on Aging, National Heart, Lung, and Blood Institute, National Institute of General Medical Sciences, National Institute of Diabetes and Digestive and Kidney Diseases, National Institute of Neurological Disorders and Stroke, National Center for Advancing Translational Sciences
Awards: G1155656840, G1304405445, G1425514332, G1442900148, G1715931998, G1937633654, G2301334622, G2573152475, G2866321202, G3042542605, G397302370, G4018866504, G4245472998, Genetic ancestry and antihypertensive medication responses in African Americans, G5068655555, G5256763093, G5497268829, G5831220822, G5971433106, G6330340713, G709749280, Model Based Approach to Improving Hypertension Control in Populations, G8450174239, G8624175963, G8723760441, G8985239187, Louisiana Clinical and Translational Science Center
OpenAlex ID: W2749174827