Abstract P308: Comparative Cost-effectiveness Of Hypertension Treatment Guidelines In US Adults

Abstract

Introduction: The 2017 ACC/AHA guidelines lowered blood pressure (BP) thresholds for hypertension diagnosis and treatment compared to the 2003 JNC7. We compared cost-effectiveness of treating to ACC/AHA and JNC7 over 10 years in untreated hypertensive adults 35-84 years of age. Methods: The Cardiovascular Disease (CVD) Policy Model simulates CVD events, deaths, and costs in US adults. Inputs are estimated from national datasets, cohort studies, and literature. We simulated three treatment strategies: (1) no pharmacological treatment; (2) full JNC7; or (3) full ACC/AHA. Base-case analyses targeted all treatment-eligible adults. Secondary analyses stratified treatment by baseline BP (130-139/80-89 vs. ≥140/90 mmHg) and indicators of high CVD risk (diabetes, CKD, CVD, or 10-yr risk ≥10%). Results: Twenty-four million untreated adults could be treated under JNC7 and 29 million under ACC/AHA, preventing 1.2 million and 1.5 million CVD events at 10 years, respectively. Treating to JNC7 compared to no treatment and ACC/AHA compared to JNC7 was cost-effective (<$50,000 per quality-adjusted life year gained) (Table). JNC7 or ACC/AHA was cost-saving for high-risk adults with BP ≥140/90 mmHg and cost-effective for high-risk adults with BP 130-139/80-89 mmHg (JNC7: $103,000/QALY; ACC/AHA: $90,000/QALY). Both JNC7 and ACC/AHA cost >$150,000 per QALY gained for treating lower risk adults. Conclusion: Treating according to either JNC7 or ACC/AHA guidelines is a cost-effective way to prevent CVD. At ten years, regardless of guideline, treating high-risk hypertensive patients is either cost-saving or cost-effective; treating lower-risk patients is relatively low value.