School of Medicine Publications and Presentations

AW-NI-5: COST-EFFECTIVENESS OF INTENSIVE VERSUS STANDARD BLOOD-PRESSURE CONTROL AMONG HYPERTENSIVE PATIENTS IN TAIWAN: A SIMULATION MODELLING STUDY

Document Type

Conference Proceeding

Publication Date

1-2023

Abstract

Objective:

Based on the Strategy of Blood Pressure Intervention in the Elderly Hypertensive Patients (STEP) trial and A Randomized Trial of Intensive versus Standard Blood-Pressure Control (SPRINT) trial, the 2022 Taiwan hypertension guidelines recommend the definition of hypertension as 130/80mmHg and a universal BP target of < 130/80 mmHg. Based on the guidelines, we aimed to analyze the lifetime cost-effectiveness of intensive versus standard blood-pressure control from the perspective of Taiwan national payer.

Design and method:

A simulation model was employed to apply the SPRINT treatment effects for hypertensive patients aged 50–54 and 55–64 years and STEP treatment effects for those aged 65–74 and 75+ years. The medical costs and utility were extracted from national sources or published data to a hypothetical cohort of SPRINT-eligible and STEP-eligible patients in Taiwan. Incremental cost-effectiveness ratio (ICER) against the willing-to-pay threshold at the one-time gross domestic product (GDP) per capita was used to evaluate whether intensive versus standard blood-pressure control was cost-effective.

Results:

Intensive blood-pressure control produced more lifetime medical costs than standard control, i.e., US$39,348–22,978 versus US$20,239–33,414, while intensive treatment also contributed to more quality-adjusted life-year (QALY), i.e., 7.60–16.28 versus 7.37–15.74. ICER values of intensive versus standard treatment were approximate US$10,989 (NT$329,670), US$11,220(NT$336,600), US$11,485(NT$344,550), and US$11,865(NT$355,950) per QALY gained for hypertensive patients aged 50–54, 55–64, 65–74, and 75+ from the perspective of Taiwanese national payer. Simulation results indicated that intensive treatment is very likely to be cost-effective, i.e., all probabilities are greater than 99.8% below the willing-to-pay threshold of US$36,000 (NT$1,080,000).

Conclusions:

In this simulation study, intensive blood-pressure control in the Taiwanese population produced fewer cardiovascular events and acceptable costs per QALY gained, enormously below the willing-to-pay threshold. The cost-effectiveness of intensive blood-pressure control was consistent across different ages, and the advantage was more predominant in younger hypertensive patients.

Comments

Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

Publication Title

Journal of Hypertension

DOI

10.1097/01.hjh.0000914136.30001.c9

Academic Level

faculty

Mentor/PI Department

Neuroscience

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