PCV10 Cost-Effectiveness of Intensive VS. Moderate Hypertension Treatment in US Adults Age 65 and Older at High Risk of Atherosclerotic Cardiovascular Disease

Abstract

Many hypertension management guidelines are available from different organizations, with no consensus on whether an intensive or moderate systolic blood pressure (SBP) management for high-risk adults aged ≥65 is better. This study aimed to assess the long-term economic value of intensive hypertension control compared with moderate control in the US elderly to guide the decision-making of hypertension treatment strategies. We developed a Markov model with a one-year time cycle to simulate the progression of stroke, coronary heart disease, and mortality over a lifetime window. We used the 2017 National Center for Health Statistics data to generate a national representative simulation sample of older adults aged ≥65. We extracted costs from the Healthcare Cost and Utilization Project Statistical Briefs and recent publications. We defined having SBP <130 mmHg as SBP control, and SBP <140 mmHg as moderate SBP control. Sensitivity analyses were conducted to assess how uncertainties of key model parameters influenced the simulation results. An incremental cost-effectiveness ratios (ICER) of ≤$50,000 per quality-adjusted life years (QALY) gained was considered as cost-effective. The mean survival time of moderate and intensive SBP control were 7.80 (95% CI 7.71-7.89) and 9.63 (95% CI 9.52-9.74) years, respectively. The incremental costs, QALYs, and life years of intensive control compared with moderate SBP control were $7,399 (95% CI $7,076- $7,722), 0.88 (95% CI 0.76-1.00), and 1.83 (95% CI 1.58-2.08) years. Comparing with moderate SBP control, intensive SBP control was cost-effective, with an ICER of $8,405/QALY (95% CI $7,960-$8,924/QALY). Sensitivity analyses showed that low medication adherence and high medication cost had moderate and high negative impacts on the cost-effectiveness of intensive SBP control, respectively. Among adults aged ≥65, aiming for an intensive SBP goal of <130 mmHg is a cost-effective strategy.