Cost-effectiveness of hypertension treatment

Cost-effectiveness of hypertension therapy based on 2020 International Society of Hypertension guidelines in Ethiopia from a societal perspective

Introduction

There is inadequate information on the cost-effectiveness of hypertension based on evidence-based guidelines. Therefore, this study was conducted to evaluate the cost-effectiveness of hypertension treatment based on 2020 International Society of Hypertension (ISH) guidelines from a societal perspective.

Methods

We developed a state-transition Markov model based on the cardiovascular disease policy model adapted to the Sub-Saharan African perspective to simulate costs of treated and untreated hypertension and disability-adjusted life-years (DALYs) averted by treating previously untreated adults above 30 years from a societal perspective for a lifetime.

Results

The full implementation of the ISH 2020 hypertension guidelines can prevent approximately 22,348.66 total productive life-year losses annually. The incremental net monetary benefit of treating hypertension based was $128,520,077.61 US by considering a willingness-to-pay threshold of $50,000 US per DALY averted. The incremental cost-effectiveness ratio (ICER) of treating hypertension when compared with null was $1,125.44 US per DALY averted. Treating hypertension among adults aged 40–64 years was very cost-effective 625.27 USD per DALY averted. Treating hypertensive adults aged 40–64 years with diabetes and CKD is very cost-effective in both women and men (i.e., 559.48 USD and 905.40 USD/DALY averted respectively).

Conclusion

The implementation of the ISH 2020 guidelines among hypertensive adults in Southern Ethiopia could result in $9,574,118.47 US economic savings. Controlling hypertension in all patients with or with diabetes and or CKD could be effective and cost-saving. Therefore, improving treatment coverage, blood pressure control rate, and adherence to treatment by involving all relevant stakeholders is critical to saving scarce health resources.

Risk of fatal and nonfatal coronary heart disease and stroke events among adult patients with hypertension: basic Markov model inputs for evaluating cost-effectiveness of hypertension treatment: systematic review of cohort studies

Objectives

Hypertension is a risk factor for a number of vascular and cardiac complications. A Markov like simulation based on cardiovascular disease (CVD) policy model is being used for evaluating cost-effectiveness of hypertension treatment. Stroke, angina, myocardial infarction (MI), cardiac arrest and all-cause mortality were only included CVD outcome variables in the model. Therefore this systematic review was conducted to evaluate completeness of CVD policy model for evaluation of cost-effectiveness across different regions.

Key findings

Fourteen cohort studies involving a total of 1 674 773 hypertensive adult population and 499 226 adults with treatment resistant hypertension were included in this systematic review. Hypertension is clearly associated with coronary heart disease (CHD) and stroke mortality, unstable angina, stable angina, MI, heart failure (HF), sudden cardiac death, transient ischemic attack, ischemic stroke, sub-arachnoid hemorrhage, intracranial hemorrhage, peripheral arterial disease (PAD), and abdominal aortic aneurism (AAA). Lifetime risk of developing HF is higher among hypertensives across all ages, with slight variation among regions. Treatment resistant hypertension is associated with higher relative risk of developing major CVD events and mortality when compared with the non-resistant hypertension.

Summary

The CVD policy model can be used in most of the regions for evaluation of cost-effectiveness of hypertension treatment. However, hypertension is highly associated with HF in Latin America, Eastern Europe, and Sub-Saharan Africa. Therefore, it is important to consider HF in CVD policy model for evaluating cost-effectiveness of hypertension treatment in these regions. We do not suggest the inclusion of PAD and AAA in CVD policy model for evaluating cost-effectiveness of hypertension treatment due to lack of sufficient evidence. Researchers should consider the effect of treatment resistant hypertension either through including in the basic model or during setting the model assumptions.

Epidemiology of essential hypertension: the role of genetic polymorphism

Over the past 20 years, the interest of the scientific community was increasingly placed in the field of genetic epidemiology and molecular genetics of blood pressure control. This paper explores references related to essential hypertension, gene and genetic epidemiology indexed in the MedLine health science database during the period 1980-2001. A systematic literature search was performed using selected keywords, such as 'genetic', 'genome' or a combination of words. We considered the study heading and evaluated the time profile of published articles. A total number of 3116 publications was collected and analyzed. Allelic distribution for the most studied polymorphisms of the renin-angiotensin system in different world populations was reviewed and reported together with a detection of their frequency in Italy: essential hypertensive patients (n = 90), healthy unrelated subjects (n = 300). Molecular variants at angiotensinogen (M and T), angiotensin II type 1 receptor (A and C) and angiotensin-converting enzyme (D and I) genes were analyzed by amplified fragment length polymorphism. A significant association was detected by chi2 analysis for angiotensinogen and angiotensin II-type I receptor allele distribution in hypertensive patients, in accordance with previous reports. Genetic data and methods are contributing more and more to epidemiological studies of complex diseases, and their application is influenced by information availability and Genome Project results.

Diagnosis and treatment of renovascular hypertension: a cost-benefit analysis

OBJECTIVE

We sought to evaluate and compare the relative cost-benefit of Doppler sonography, MR angiography, and captopril-enhanced renal scintigraphy as techniques for predicting a patient's clinical response to renal angioplasty.

MATERIALS AND METHODS

Estimations of positive and negative predictive values of baseline and captopril-enhanced renal scintigraphy and Doppler sonography examinations for predicting a favorable outcome after renal angioplasty were based on a previously published prospective study involving 74 patients who underwent this treatment. For gadolinium-enhanced MR angiography, predictive values were calculated from a subpopulation of 57 of these 74 subjects. The value of different combined strategies with these techniques for predicting clinical success after angioplasty was evaluated in this population. The costs of investigation and treatment per improved patient were calculated for each imaging technique and for combined strategies in a hypothetic 1,000-patient population with a 30% prevalence of renal artery stenosis, relying on the diagnostic performance reported in the literature for each technique in detecting renal artery stenosis.

RESULTS

The costs for each improved patient were $12,579 for patients selected on the basis of a positive finding on Doppler sonography (false-negative results = 12/1,000) and $10,149 for patients selected with criteria combining a positive finding on Doppler sonography with a bilateral resistive index of less than 0.75 (false-negative results = 32/1,000). Patient selection based on a positive finding on MR angiography cost $18,119 (false-negative results = 0), whereas the cost of patient selection based on a positive finding on renal scintigraphy was $12,939 (false-negative results = 29/1,000).

CONCLUSION

Doppler sonography is more cost-efficient but less sensitive than MR angiography for identifying patients with renovascular hypertension. MR angiography should be favored in hypertensive patients who are resistant to medical therapy to avoid false-negative examinations.

The cost-effectiveness of candesartan-based antihypertensive treatment for the prevention of nonfatal stroke: results from the Study on COgnition and Prognosis in the Elderly

Patients who survive a first stroke are often left with permanent disabilities, and have significant needs for rehabilitation and long-term care. Antihypertensive treatment reduces the risk of cardiovascular events such as stroke. The purpose of this study was to investigate the cost-effectiveness of candesartan-based antihypertensive treatment for the prevention of nonfatal stroke. The cost-effectiveness analysis was based on data from Study on COgnition and Prognosis in the Elderly (SCOPE), where patients were randomly assigned to receive the angiotensin receptor blocker candesartan or placebo, with open-label active antihypertensive treatment added as needed. The analysis was carried out using a Markov model, which combined clinical and resource utilization data from SCOPE with Swedish retail prices for drugs and unit costs for in-patient stays, and outpatient visits. The cost per patient was 1949 EUR in the candesartan group and 1578 EUR in the control group. The largest share of the cost was attributed to antihypertensive treatment in the candesartan group and to the long-term cost of stroke in the control group. Candesartan-based antihypertensive treatment was associated with 0.0289 additional quality-adjusted life-years (QALYs) per patient and an incremental cost per QALY gained of approximately 13,000 EUR. Sensitivity analyses showed that these results were fairly stable. In conclusion, the cost per QALY gained with candesartan-based antihypertensive treatment lies within the range of society's willingness to pay for health gains. The results indicate that candesartan-based antihypertensive treatment is cost-effective for the prevention of nonfatal stroke.

Disease management and pharmacoeconomics as tools for mass prevention of hypertensive complications

Hypertension has been identified as a major predictor of cardiovascular disease, which is a worldwide cause of morbidity and premature mortality. Optimal management of hypertension involves finding a balance among the benefits, risks, and costs of disease treatment and prevention of hypertensive sequelae. Cost-effectiveness analysis helps to clarify the trade-offs between the costs and benefits of treatment and also to evaluate the effects on quality of therapy. Disease management programs that incorporate pharmacoeconomic analysis and computerized methods of targeting patients at high risk of hypertensive sequelae are useful and cost-effective tools. Critical to these cost-effectiveness analyses and disease management programs are the expected benefits attributable to blood pressure reduction. The utility of these programs in helping to determine which patients will benefit from intensive intervention depends to a great extent on the assumptions made and the quality of the data used for the analyses--that is, the degree to which the data are evidence based.

Event-related potentials in the elderly with new mild hypertension

Hypertension is a risk factor for cerebrovascular diseases (CVD) and cognitive impairment and the relative risk of CVD at every level of blood pressure (BP) is greater among the elderly. We submitted 20 elderly affected by new mild hypertension and 10 elderly normotensives to 24-hour ambulatory BP monitoring (ABPM), to evaluate their cognitive state using the Mini-Mental-State-Examination and to the recording of related acoustic evoked potentials (P300 and N2). We did not find significant differences for P300 latency between hypertensives and normotensives, while N2 latency recording showed a statistically significant protracted value in elderly hypertensives. In these patients we found a significant correlation between the N2 latency and systolic blood pressure values recorded by ABPM. These results demonstrated early functional alterations of cognitive state in elderly hypertensives, that are related to systolic blood pressure and future data might point to an earlier use of therapy.