BACKGROUND: Mounting evidence shows that multi-intervention programmes for hypertension treatment are more effective than an isolated pharmacological strategy. Full economic evaluations of hypertension management programmes are scarce and contain methodological limitations. The aim of the study was to evaluate if a hypertension management programme for elderly patients is cost-effective compared to usual care from the perspective of a third-party payer. METHODS: We built a cost-effectiveness model using published evidence of effectiveness of a comprehensive hypertension programme vs. usual care for patients 65 years or older at a community hospital in Buenos Aires, Argentina. We explored incremental cost-effectiveness between groups. The model used a life-time framework adopting a third-party payer's perspective. Incremental cost-effectiveness ratio (ICER) was calculated in International Dollars per life-year gained. We performed a probabilistic sensitivity analysis (PSA) to explore variable uncertainty. RESULTS: The ICER for the base-case of the "Hypertension Programme" versus the "Usual care" approach was 1,124 International Dollars per life-year gained. PSA did not significantly influence results. The programme had a probability of 43% of being dominant (more effective and less costly) and, overall, 95% chance of being cost-effective. DISCUSSION: Results showed that "Hypertension Programme" had high probabilities of being cost-effective under a wide range of scenarios. This is the first sound cost-effectiveness study to assess a comprehensive hypertension programme versus usual care. This study measures hard outcomes and explores robustness through a probabilistic sensitivity analysis. CONCLUSIONS: The comprehensive hypertension programme had high probabilities of being cost-effective versus usual care. This study supports the idea that similar programmes could be the preferred strategy in countries and within health care systems where hypertension treatment for elderly patients is a standard practice.
BACKGROUND: Mounting evidence shows that multi-intervention programmes for hypertension treatment are more effective than an isolated pharmacological strategy. Full economic evaluations of hypertension management programmes are scarce and contain methodological limitations. The aim of the study was to evaluate if a hypertension management programme for elderly patients is cost-effective compared to usual care from the perspective of a third-party payer. METHODS: We built a cost-effectiveness model using published evidence of effectiveness of a comprehensive hypertension programme vs. usual care for patients 65 years or older at a community hospital in Buenos Aires, Argentina. We explored incremental cost-effectiveness between groups. The model used a life-time framework adopting a third-party payer's perspective. Incremental cost-effectiveness ratio (ICER) was calculated in International Dollars per life-year gained. We performed a probabilistic sensitivity analysis (PSA) to explore variable uncertainty. RESULTS: The ICER for the base-case of the "Hypertension Programme" versus the "Usual care" approach was 1,124 International Dollars per life-year gained. PSA did not significantly influence results. The programme had a probability of 43% of being dominant (more effective and less costly) and, overall, 95% chance of being cost-effective. DISCUSSION: Results showed that "Hypertension Programme" had high probabilities of being cost-effective under a wide range of scenarios. This is the first sound cost-effectiveness study to assess a comprehensive hypertension programme versus usual care. This study measures hard outcomes and explores robustness through a probabilistic sensitivity analysis. CONCLUSIONS: The comprehensive hypertension programme had high probabilities of being cost-effective versus usual care. This study supports the idea that similar programmes could be the preferred strategy in countries and within health care systems where hypertension treatment for elderly patients is a standard practice.
Authors: David P Faxon; Lee H Schwamm; Richard C Pasternak; Eric D Peterson; Barbara Joyce McNeil; Vincent Bufalino; Clyde W Yancy; Lawrence M Brass; David W Baker; Robert O Bonow; Lynn A Smaha; Daniel W Jones; Sidney C Smith; Gray Ellrodt; Jerilyn Allen; Sanford J Schwartz; Gregg Fonarow; Pam Duncan; Katie Horton; Renee Smith; Steve Stranne; Kenneth Shine Journal: Stroke Date: 2004-06 Impact factor: 7.914
Authors: J A Staessen; R Fagard; L Thijs; H Celis; G G Arabidze; W H Birkenhäger; C J Bulpitt; P W de Leeuw; C T Dollery; A E Fletcher; F Forette; G Leonetti; C Nachev; E T O'Brien; J Rosenfeld; J L Rodicio; J Tuomilehto; A Zanchetti Journal: Lancet Date: 1997-09-13 Impact factor: 79.321
Authors: F Gueyffier; F Boutitie; J P Boissel; S Pocock; J Coope; J Cutler; T Ekbom; R Fagard; L Friedman; M Perry; R Prineas; E Schron Journal: Ann Intern Med Date: 1997-05-15 Impact factor: 25.391
Authors: Ralph B D'Agostino; Ramachandran S Vasan; Michael J Pencina; Philip A Wolf; Mark Cobain; Joseph M Massaro; William B Kannel Journal: Circulation Date: 2008-01-22 Impact factor: 29.690
Authors: Parastu Kasaie; Brian Weir; Melissa Schnure; Chen Dun; Jeff Pennington; Yu Teng; Richard Wamai; Kipkoech Mutai; David Dowdy; Chris Beyrer Journal: J Int AIDS Soc Date: 2020-06 Impact factor: 5.396