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J Pediatr. 2011 Feb;158(2):257-64.e1-7. doi: 10.1016/j.jpeds.2010.07.058. Epub 2010 Sep 17.

Effectiveness and cost-effectiveness of blood pressure screening in adolescents in the United States.

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  • 1Department of Health Policy and Management, Columbia Mailman School of Public Health, New York, NY, USA.

Abstract

OBJECTIVE:

To compare the long-term effectiveness and cost-effectiveness of 3 approaches to managing elevated blood pressure (BP) in adolescents in the United States: no intervention, "screen-and-treat," and population-wide strategies to lower the entire BP distribution.

STUDY DESIGN:

We used a simulation model to combine several data sources to project the lifetime costs and cardiovascular outcomes for a cohort of 15-year-old U.S. adolescents under different BP approaches and conducted cost-effectiveness analysis. We obtained BP distributions from the National Health and Nutrition Examination Survey 1999-2004 and used childhood-to-adult longitudinal correlation analyses to simulate the tracking of BP. We then used the coronary heart disease policy model to estimate lifetime coronary heart disease events, costs, and quality-adjusted life years (QALY).

RESULTS:

Among screen-and-treat strategies, finding and treating the adolescents at highest risk (eg, left ventricular hypertrophy) was most cost-effective ($18000/QALY [boys] and $47000/QALY [girls]). However, all screen-and-treat strategies were dominated by population-wide strategies such as salt reduction (cost-saving [boys] and $650/QALY [girls]) and increasing physical education ($11000/QALY [boys] and $35000/QALY [girls]).

CONCLUSIONS:

Routine adolescents BP screening is moderately effective, but population-based BP interventions with broader reach could potentially be less costly and more effective for early cardiovascular disease prevention and should be implemented in parallel.

Copyright © 2011 Mosby, Inc. All rights reserved.

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PMID:
20850759
[PubMed - indexed for MEDLINE]
PMCID:
PMC4007283
Free PMC Article
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