Format

Send to

Choose Destination
Am J Hypertens. 2016 Oct;29(10):1195-205. doi: 10.1093/ajh/hpw047. Epub 2016 May 12.

Comparative Cost-Effectiveness of Hypertension Treatment in Non-Hispanic Blacks and Whites According to 2014 Guidelines: A Modeling Study.

Author information

1
College of Physicians and Surgeons, Columbia University, New York, USA;
2
Department of General Medicine, Columbia University Medical Center, New York, USA;
3
Department of Evidence Based Medicine, Cardiovascular Institute and Fu Wai Hospital of the Chinese Academy of Medical Sciences, Beijing, China; National Center for Cardiovascular Diseases, Beijing, China;
4
Department of Medicine, University of California at San Francisco, San Francisco, California, USA.
5
College of Physicians and Surgeons, Columbia University, New York, USA; Department of General Medicine, Columbia University Medical Center, New York, USA; aem35@cumc.columbia.edu.

Abstract

BACKGROUND:

We compared the cost-effectiveness of hypertension treatment in non-Hispanic blacks and non-Hispanic whites according to 2014 US hypertension treatment guidelines.

METHODS:

The cardiovascular disease (CVD) policy model simulated CVD events, quality-adjusted life years (QALYs), and treatment costs in 35- to 74-year-old adults with untreated hypertension. CVD incidence, mortality, and risk factor levels were obtained from cohort studies, hospital registries, vital statistics, and national surveys. Stage 1 hypertension was defined as blood pressure 140-149/90-99mm Hg; stage 2 hypertension as ≥150/100mm Hg. Probabilistic input distribution sampling informed 95% uncertainty intervals (UIs). Incremental cost-effectiveness ratios (ICERs) < $50,000/QALY gained were considered cost-effective.

RESULTS:

Treating 0.7 million hypertensive non-Hispanic black adults would prevent about 8,000 CVD events annually; treating 3.4 million non-Hispanic whites would prevent about 35,000 events. Overall 2014 guideline implementation would be cost saving in both groups compared with no treatment. For stage 1 hypertension but without diabetes or chronic kidney disease, cost savings extended to non-Hispanic black males ages 35-44 but not same-aged non-Hispanic white males (ICER $57,000/QALY; 95% UI $15,000-$100,000) and cost-effectiveness extended to non-Hispanic black females ages 35-44 (ICER $46,000/QALY; $17,000-$76,000) but not same-aged non-Hispanic white females (ICER $181,000/QALY; $111,000-$235,000).

CONCLUSIONS:

Compared with non-Hispanic whites, cost-effectiveness of implementing hypertension guidelines would extend to a larger proportion of non-Hispanic black hypertensive patients.

KEYWORDS:

blood pressure; cost-effectiveness; hypertension; race.

PMID:
27172970
PMCID:
PMC5018997
DOI:
10.1093/ajh/hpw047
[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for Silverchair Information Systems Icon for PubMed Central
Loading ...
Support Center