Sanjay Basu1, John S Yudkin2, Jeremy B Sussman2, Christopher Millett2, Rodney A Hayward2. 1. From Department of Medicine, Stanford University, Stanford, CA (S.B.); Center for Primary Care, Harvard Medical School, Boston, MA (S.B.); Division of Medicine, University College London, London, United Kingdom (J.S.Y.); Division of General Medicine, University of Michigan, Ann Arbor, MI (J.B.S., R.A.H.); Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI (J.B.S., R.A.H.); School of Public Health, Imperial College London. London, United Kingdom (C.M.); and Public Health Foundation of India, New Delhi, India (C.M.). basus@stanford.edu. 2. From Department of Medicine, Stanford University, Stanford, CA (S.B.); Center for Primary Care, Harvard Medical School, Boston, MA (S.B.); Division of Medicine, University College London, London, United Kingdom (J.S.Y.); Division of General Medicine, University of Michigan, Ann Arbor, MI (J.B.S., R.A.H.); Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI (J.B.S., R.A.H.); School of Public Health, Imperial College London. London, United Kingdom (C.M.); and Public Health Foundation of India, New Delhi, India (C.M.).
Abstract
BACKGROUND: The World Health Organization aims to reduce mortality from chronic diseases including cardiovascular disease (CVD) by 25% by 2025. High blood pressure is a leading CVD risk factor. We sought to compare 3 strategies for treating blood pressure in China and India: a treat-to-target (TTT) strategy emphasizing lowering blood pressure to a target, a benefit-based tailored treatment (BTT) strategy emphasizing lowering CVD risk, or a hybrid strategy currently recommended by the World Health Organization. METHODS AND RESULTS: We developed a microsimulation model of adults aged 30 to 70 years in China and in India to compare the 2 treatment approaches across a 10-year policy-planning horizon. In the model, a BTT strategy treating adults with a 10-year CVD event risk of ≥ 10% used similar financial resources but averted ≈ 5 million more disability-adjusted life-years in both China and India than a TTT approach based on current US guidelines. The hybrid strategy in the current World Health Organization guidelines produced no substantial benefits over TTT. BTT was more cost-effective at $205 to $272/disability-adjusted life-year averted, which was $142 to $182 less per disability-adjusted life-year than TTT or hybrid strategies. The comparative effectiveness of BTT was robust to uncertainties in CVD risk estimation and to variations in the age range analyzed, the BTT treatment threshold, or rates of treatment access, adherence, or concurrent statin therapy. CONCLUSIONS: In model-based analyses, a simple BTT strategy was more effective and cost-effective than TTT or hybrid strategies in reducing mortality.
BACKGROUND: The World Health Organization aims to reduce mortality from chronic diseases including cardiovascular disease (CVD) by 25% by 2025. High blood pressure is a leading CVD risk factor. We sought to compare 3 strategies for treating blood pressure in China and India: a treat-to-target (TTT) strategy emphasizing lowering blood pressure to a target, a benefit-based tailored treatment (BTT) strategy emphasizing lowering CVD risk, or a hybrid strategy currently recommended by the World Health Organization. METHODS AND RESULTS: We developed a microsimulation model of adults aged 30 to 70 years in China and in India to compare the 2 treatment approaches across a 10-year policy-planning horizon. In the model, a BTT strategy treating adults with a 10-year CVD event risk of ≥ 10% used similar financial resources but averted ≈ 5 million more disability-adjusted life-years in both China and India than a TTT approach based on current US guidelines. The hybrid strategy in the current World Health Organization guidelines produced no substantial benefits over TTT. BTT was more cost-effective at $205 to $272/disability-adjusted life-year averted, which was $142 to $182 less per disability-adjusted life-year than TTT or hybrid strategies. The comparative effectiveness of BTT was robust to uncertainties in CVD risk estimation and to variations in the age range analyzed, the BTT treatment threshold, or rates of treatment access, adherence, or concurrent statin therapy. CONCLUSIONS: In model-based analyses, a simple BTT strategy was more effective and cost-effective than TTT or hybrid strategies in reducing mortality.
Authors: L Kristin Newby; Nancy M Allen LaPointe; Anita Y Chen; Judith M Kramer; Bradley G Hammill; Elizabeth R DeLong; Lawrence H Muhlbaier; Robert M Califf Journal: Circulation Date: 2006-01-09 Impact factor: 29.690
Authors: Florent Boutitie; François Gueyffier; Stuart Pocock; Robert Fagard; Jean Pierre Boissel Journal: Ann Intern Med Date: 2002-03-19 Impact factor: 25.391
Authors: C Baigent; A Keech; P M Kearney; L Blackwell; G Buck; C Pollicino; A Kirby; T Sourjina; R Peto; R Collins; R Simes Journal: Lancet Date: 2005-09-27 Impact factor: 79.321
Authors: Jun Wu; Aldi T Kraja; Al Oberman; Cora E Lewis; R Curtis Ellison; Donna K Arnett; Gerardo Heiss; Jean-Marc Lalouel; Stephen T Turner; Steven C Hunt; Michael A Province; D C Rao Journal: Am J Hypertens Date: 2005-07 Impact factor: 2.689
Authors: Stephen S Lim; Thomas A Gaziano; Emmanuela Gakidou; K Srinath Reddy; Farshad Farzadfar; Rafael Lozano; Anthony Rodgers Journal: Lancet Date: 2007-12-11 Impact factor: 79.321
Authors: Shanthi Mendis; Lars H Lindholm; Giuseppe Mancia; Judith Whitworth; Michael Alderman; Stephen Lim; Tony Heagerty Journal: J Hypertens Date: 2007-08 Impact factor: 4.844
Authors: Phil Symonds; Emma Hutchinson; Andrew Ibbetson; Jonathon Taylor; James Milner; Zaid Chalabi; Michael Davies; Paul Wilkinson Journal: Sci Total Environ Date: 2019-08-29 Impact factor: 7.963