Abstract
Objective The current literature suggests that more intensive blood pressure (BP) treatment is clinically more effective than less intensive treatment in patients at high risk for cardiovascular disease (CVD). In this analysis, we evaluated the potential clinical benefit and cost-effectiveness of more intensive BP treatment in patients at high risk of developing CVD over their lifetimes. Methods A Markov state-transition model was developed for the BP strategies to estimate the lifetime incremental cost-effectiveness ratio (ICER) per quality-adjusted-life-year (QALY) using evidence published from a meta-analysis. The other model inputs were retrieved from previous studies. Estimated costs were collected from five hospitals in Riyadh. The model used a lifetime framework adopting Saudi payer perspective and applied a 3% annual discount rate. Sensitivity analysis was conducted using one-way and probabilistic sensitivity analysis (PSA) to evaluate the robustness and uncertainty of the estimates. Results Treating 10,000 patients with high CVD risk with more intensive BP therapy would avert a total of 873 CV events over their remaining lifetimes as compared with a less intensive strategy. The projections showed that more intensive BP therapy would be cost-effective compared to the less intensive strategy with incremental costs per QALY of $20,358. Probabilistic sensitivity analysis suggested more intensive control would be cost-effective compared with the less intensive control of BP 87.25 % of the time. Conclusion The result of this study showed that more intensive BP treatment appears to be a cost-effective choice for patients with a high risk of CVD in Saudi Arabia when compared with a less intensive BP strategy. Thus, this finding provides strong evidence for the adoption of this strategy within the Saudi healthcare system.
Highlights
Cardiovascular disease (CVD) is recognized as a major cause of morbidity and mortality worldwide. e World Health Organization (WHO) reported that 17.9 million individuals died from CVDs in 2016, accounting for 31% of all-cause mortality globally [1]
The WHO reported that 37% of deaths in Saudi Arabia could be attributed to CVDs [2], which is higher than the global estimate
According to evidence derived from a recent meta-analysis aimed to quantify the benefits and harm of the more intensive blood pressure (BP) treatment, more intensive BP treatment provided greater vascular protection than less intensive BP treatment [28]
Summary
Cardiovascular disease (CVD) is recognized as a major cause of morbidity and mortality worldwide. e World Health Organization (WHO) reported that 17.9 million individuals died from CVDs in 2016, accounting for 31% of all-cause mortality globally [1]. Cardiovascular disease (CVD) is recognized as a major cause of morbidity and mortality worldwide. E World Health Organization (WHO) reported that 17.9 million individuals died from CVDs in 2016, accounting for 31% of all-cause mortality globally [1]. Limited evidence exists on the prevalence of CVD-related mortality in Saudi Arabia. The WHO reported that 37% of deaths in Saudi Arabia could be attributed to CVDs [2], which is higher than the global estimate. In Saudi Arabia, nearly 19% of adults have high BP [2], with 56.6% at higher risk of developing CVD [4]. There has been an increased focus on intensive BP-lowering treatment in the routine follow-up of people at high risk of CVD. Previous studies affirmed the benefits of more intensive BP treatment
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