Tao Chen1, Dahai Yu2, Victoria Cornelius3, Rui Qin4, Yamei Cai5, Zhixin Jiang6, Zhanzheng Zhao7. 1. Department of Nephrology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou 450052, China; Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK; Department of Epidemiology and Biostatistics, Nanjing Medical University, Nanjing 210029, China. 2. Department of Nephrology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou 450052, China; Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Keele ST5 5BG, UK. 3. Imperial Clinical Trials Unit, School of Public Health, Imperial College London, London W12 7RH, UK. 4. Jiangsu Province Hospital on Integration of Chinese and Western Medicine, Nanjing 210028, China. 5. Department of Nephrology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou 450052, China. 6. Department of Cardiology, Jiangsu Province People's Hospital, Nanjing 210029, China. 7. Department of Nephrology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou 450052, China. Electronic address: zhanzhengzhao@zzu.edu.cn.
Abstract
BACKGROUND: Studies have reported that pharmacologic interventions with candesartan or ramipril could reduce the risk of hypertension among prehypertensive subjects free of clinical cardiovascular disease (CVD), however, the cost-effectiveness and long-term cardiovascular risk of drug treatment among these population is unclear. METHOD: A Markov state-transition model was developed to simulate a hypothetical cohort of Chinese adults with high-range prehypertension (130-139/85-89mmHg) but without CVD. Data on the incidence of CVD and hypertension was obtained from corresponding risk equations. Utility and disease-related costs were obtained from published literatures. Robustness and uncertainty was evaluated using deterministic and probabilistic sensitivity analyses. RESULTS: Compared with placebo, drug treatment resulted in delaying the development of hypertension by nearly 12years and reducing the absolute incidence of hypertension by 32.01% over lifetime. The cumulative incidence of coronary heart disease, stroke and heart failure were reduced and survival was improved from 28.46 to 28.80years. The average incremental cost effectiveness ratio for drug treatment was $12,994 per quality-adjusted life-year and the value was mostly sensitive to the effect size of treatment and age starting treatment. At a willingness-to-pay threshold of >3×China gross domestic product per capita in 2014, there was a 30.48% chance that drug treatment would remain cost-effective and a low chance of being cost-effective if relative risk of treatment on hypertension was larger than 0.64. CONCLUSION: Drug treatment for prehypertension may help stem the current epidemic of hypertension among Chinese adults free of CVD, which may in turn reduce CVD complications and potentially be cost effective.
BACKGROUND: Studies have reported that pharmacologic interventions with candesartan or ramipril could reduce the risk of hypertension among prehypertensive subjects free of clinical cardiovascular disease (CVD), however, the cost-effectiveness and long-term cardiovascular risk of drug treatment among these population is unclear. METHOD: A Markov state-transition model was developed to simulate a hypothetical cohort of Chinese adults with high-range prehypertension (130-139/85-89mmHg) but without CVD. Data on the incidence of CVD and hypertension was obtained from corresponding risk equations. Utility and disease-related costs were obtained from published literatures. Robustness and uncertainty was evaluated using deterministic and probabilistic sensitivity analyses. RESULTS: Compared with placebo, drug treatment resulted in delaying the development of hypertension by nearly 12years and reducing the absolute incidence of hypertension by 32.01% over lifetime. The cumulative incidence of coronary heart disease, stroke and heart failure were reduced and survival was improved from 28.46 to 28.80years. The average incremental cost effectiveness ratio for drug treatment was $12,994 per quality-adjusted life-year and the value was mostly sensitive to the effect size of treatment and age starting treatment. At a willingness-to-pay threshold of >3×China gross domestic product per capita in 2014, there was a 30.48% chance that drug treatment would remain cost-effective and a low chance of being cost-effective if relative risk of treatment on hypertension was larger than 0.64. CONCLUSION: Drug treatment for prehypertension may help stem the current epidemic of hypertension among Chinese adults free of CVD, which may in turn reduce CVD complications and potentially be cost effective.
Authors: Deliana Kostova; Garrison Spencer; Andrew E Moran; Laura K Cobb; Muhammad Jami Husain; Biplab Kumar Datta; Kunihiro Matsushita; Rachel Nugent Journal: BMJ Glob Health Date: 2020-09-09