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N Engl J Med. 2017 Aug 24;377(8):745-755. doi: 10.1056/NEJMsa1616035.

Cost-Effectiveness of Intensive versus Standard Blood-Pressure Control.

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From the Departments of Population Health Sciences (A.P.B., R.H., M.B.C.) and Pharmacotherapy (B.K.B., N.R.-N.) and the Divisions of General Internal Medicine (R.H., M.B.C.), Nephrology and Hypertension (S.B., A.K.C.), and Geriatrics (M.A.S.), Department of Internal Medicine, University of Utah School of Medicine, Medical Service, Veterans Affairs (VA) Salt Lake City Healthcare System (S.B., A.K.C.), and VA Salt Lake City Geriatric Research, Education and Clinical Center (M.A.S.), Salt Lake City, and SelectHealth, Murray (B.K.B., N.R.-N.) - all in Utah; Pharmacy Department, Kaiser Permanente Colorado, Aurora (J.B.K.); Christiana Care Health System, Newark, DE (Z.Z., W.S.W.); Center for Healthcare Organization and Implementation Research, Bedford VA Medical Center, Bedford, and the Department of Health Law, Policy, and Management, Boston University School of Public Health (D.R.B.), and the Department of Health Law, Policy and Management, Center for the Assessment of Pharmaceutical Practices, Boston University School of Public Health, Boston (L.E.K.) - all in Massachusetts; Clinical Applications and Prevention Branch, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (L.F.); Vascular Biology and Hypertension Program, Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham (S.O.); Fielding School of Public Health, Department of Community Health Sciences, University of California, Los Angeles, Los Angeles (D.E.M.); the Division of General Internal Medicine, Brody School of Medicine, East Carolina University, Greenville, NC (J.P.); the Division of Population Health and Computational Medicine, University of Miami and Geriatric Research, Education and Clinical Center, Miami VA, Miami (L.T.); Clement J. Zablocki VA Medical Center, Milwaukee, and the Department of Medicine, Medical College of Wisconsin, Wauwatosa (J.W.) - both in Wisconsin; the Division of Nephrology and Hypertension, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland (J.T.W.); and the Division of General Medicine, Department of Medicine, Columbia University Medical Center, New York (A.E.M.).



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.


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.


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.


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 number, NCT01206062 .).

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