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The Cost-Effectiveness of Low-Cost Essential Antihypertensive Medicines for Hypertension Control in China: A Modelling Study.

Gu D, He J, Coxson PG, Rasmussen PW, Huang C, Thanataveerat A, Tzong KY, Xiong J, Wang M, Zhao D, Goldman L, Moran AE - PLoS Med. (2015)

Bottom Line: Treatment of isolated systolic hypertension and combined systolic and diastolic hypertension were modeled as a reduction in systolic blood pressure; treatment of isolated diastolic hypertension was modeled as a reduction in diastolic blood pressure.Median antihypertensive costs from Shanghai and Yunnan province were entered into the model in order to estimate the effects of very low and high drug prices.Incremental cost-effectiveness ratios less than the per capita gross domestic product of China (11,900 international dollars [Int$] in 2015) were considered cost-effective.

View Article: PubMed Central - PubMed

Affiliation: Department of Epidemiology, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; National Center for Cardiovascular Diseases, Beijing, China.

ABSTRACT

Background: Hypertension is China's leading cardiovascular disease risk factor. Improved hypertension control in China would result in result in enormous health gains in the world's largest population. A computer simulation model projected the cost-effectiveness of hypertension treatment in Chinese adults, assuming a range of essential medicines list drug costs.

Methods and findings: The Cardiovascular Disease Policy Model-China, a Markov-style computer simulation model, simulated hypertension screening, essential medicines program implementation, hypertension control program administration, drug treatment and monitoring costs, disease-related costs, and quality-adjusted life years (QALYs) gained by preventing cardiovascular disease or lost because of drug side effects in untreated hypertensive adults aged 35-84 y over 2015-2025. Cost-effectiveness was assessed in cardiovascular disease patients (secondary prevention) and for two blood pressure ranges in primary prevention (stage one, 140-159/90-99 mm Hg; stage two, ≥160/≥100 mm Hg). Treatment of isolated systolic hypertension and combined systolic and diastolic hypertension were modeled as a reduction in systolic blood pressure; treatment of isolated diastolic hypertension was modeled as a reduction in diastolic blood pressure. One-way and probabilistic sensitivity analyses explored ranges of antihypertensive drug effectiveness and costs, monitoring frequency, medication adherence, side effect severity, background hypertension prevalence, antihypertensive medication treatment, case fatality, incidence and prevalence, and cardiovascular disease treatment costs. Median antihypertensive costs from Shanghai and Yunnan province were entered into the model in order to estimate the effects of very low and high drug prices. Incremental cost-effectiveness ratios less than the per capita gross domestic product of China (11,900 international dollars [Int$] in 2015) were considered cost-effective. Treating hypertensive adults with prior cardiovascular disease for secondary prevention was projected to be cost saving in the main simulation and 100% of probabilistic simulation results. Treating all hypertension for primary and secondary prevention would prevent about 800,000 cardiovascular disease events annually (95% uncertainty interval, 0.6 to 1.0 million) and was borderline cost-effective incremental to treating only cardiovascular disease and stage two patients (2015 Int$13,000 per QALY gained [95% uncertainty interval, Int$10,000 to Int$18,000]). Of all one-way sensitivity analyses, assuming adherence to taking medications as low as 25%, high Shanghai drug costs, or low medication efficacy led to the most unfavorable results (treating all hypertension, about Int$47,000, Int$37,000, and Int$27,000 per QALY were gained, respectively). The strengths of this study were the use of a recent Chinese national health survey, vital statistics, health care costs, and cohort study outcomes data as model inputs and reliance on clinical-trial-based estimates of coronary heart disease and stroke risk reduction due to antihypertensive medication treatment. The limitations of the study were the use of several sources of data, limited clinical trial evidence for medication effectiveness and harms in the youngest and oldest age groups, lack of information about geographic and ethnic subgroups, lack of specific information about indirect costs borne by patients, and uncertainty about the future epidemiology of cardiovascular diseases in China.

Conclusions: Expanded hypertension treatment has the potential to prevent about 800,000 cardiovascular disease events annually and be borderline cost-effective in China, provided low-cost essential antihypertensive medicines programs can be implemented.

No MeSH data available.


Related in: MedlinePlus

Cost-effectiveness acceptability curves comparing treating all untreated hypertensive adults (blue) with treating only untreated CVD patients and adults with stage 2 hypertension but without CVD (red).The threshold for cost-effective in China assumed for this analysis is labeled at Int$11,900 (China’s GDP per capita; conversion to US dollars from Chinese RMB based on PPP). Twice China’s GDP is also labelled at Int$23,800.
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pmed.1001860.g002: Cost-effectiveness acceptability curves comparing treating all untreated hypertensive adults (blue) with treating only untreated CVD patients and adults with stage 2 hypertension but without CVD (red).The threshold for cost-effective in China assumed for this analysis is labeled at Int$11,900 (China’s GDP per capita; conversion to US dollars from Chinese RMB based on PPP). Twice China’s GDP is also labelled at Int$23,800.

Mentions: Treating hypertension in CVD patients was projected to save costs in 100% of probabilistic simulations. Incrementally adding treatment of stage two patients was projected to be cost-effective (Int$9,000 per QALY gained, [95% uncertainty range Int$7,000 to Int$12,000], Table 2 and S7 Table). Treating all untreated hypertensive patients (primary and secondary prevention) was projected to be borderline cost-effective compared with treating stage two and CVD patients alone (about Int$13,000 per QALY gained, [Int$10,000 to Int$18,000]). At a willingness-to-pay threshold of the GDP per capita of China (Int$11,900 in 2015), treating all hypertensives was the most cost-effective strategy in 63% of probabilistic simulations (Fig 2). At thresholds of Int$19,000 and above, treating all hypertensive adults was the most cost-effective strategy in 100% of simulations.


The Cost-Effectiveness of Low-Cost Essential Antihypertensive Medicines for Hypertension Control in China: A Modelling Study.

Gu D, He J, Coxson PG, Rasmussen PW, Huang C, Thanataveerat A, Tzong KY, Xiong J, Wang M, Zhao D, Goldman L, Moran AE - PLoS Med. (2015)

Cost-effectiveness acceptability curves comparing treating all untreated hypertensive adults (blue) with treating only untreated CVD patients and adults with stage 2 hypertension but without CVD (red).The threshold for cost-effective in China assumed for this analysis is labeled at Int$11,900 (China’s GDP per capita; conversion to US dollars from Chinese RMB based on PPP). Twice China’s GDP is also labelled at Int$23,800.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4524696&req=5

pmed.1001860.g002: Cost-effectiveness acceptability curves comparing treating all untreated hypertensive adults (blue) with treating only untreated CVD patients and adults with stage 2 hypertension but without CVD (red).The threshold for cost-effective in China assumed for this analysis is labeled at Int$11,900 (China’s GDP per capita; conversion to US dollars from Chinese RMB based on PPP). Twice China’s GDP is also labelled at Int$23,800.
Mentions: Treating hypertension in CVD patients was projected to save costs in 100% of probabilistic simulations. Incrementally adding treatment of stage two patients was projected to be cost-effective (Int$9,000 per QALY gained, [95% uncertainty range Int$7,000 to Int$12,000], Table 2 and S7 Table). Treating all untreated hypertensive patients (primary and secondary prevention) was projected to be borderline cost-effective compared with treating stage two and CVD patients alone (about Int$13,000 per QALY gained, [Int$10,000 to Int$18,000]). At a willingness-to-pay threshold of the GDP per capita of China (Int$11,900 in 2015), treating all hypertensives was the most cost-effective strategy in 63% of probabilistic simulations (Fig 2). At thresholds of Int$19,000 and above, treating all hypertensive adults was the most cost-effective strategy in 100% of simulations.

Bottom Line: Treatment of isolated systolic hypertension and combined systolic and diastolic hypertension were modeled as a reduction in systolic blood pressure; treatment of isolated diastolic hypertension was modeled as a reduction in diastolic blood pressure.Median antihypertensive costs from Shanghai and Yunnan province were entered into the model in order to estimate the effects of very low and high drug prices.Incremental cost-effectiveness ratios less than the per capita gross domestic product of China (11,900 international dollars [Int$] in 2015) were considered cost-effective.

View Article: PubMed Central - PubMed

Affiliation: Department of Epidemiology, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; National Center for Cardiovascular Diseases, Beijing, China.

ABSTRACT

Background: Hypertension is China's leading cardiovascular disease risk factor. Improved hypertension control in China would result in result in enormous health gains in the world's largest population. A computer simulation model projected the cost-effectiveness of hypertension treatment in Chinese adults, assuming a range of essential medicines list drug costs.

Methods and findings: The Cardiovascular Disease Policy Model-China, a Markov-style computer simulation model, simulated hypertension screening, essential medicines program implementation, hypertension control program administration, drug treatment and monitoring costs, disease-related costs, and quality-adjusted life years (QALYs) gained by preventing cardiovascular disease or lost because of drug side effects in untreated hypertensive adults aged 35-84 y over 2015-2025. Cost-effectiveness was assessed in cardiovascular disease patients (secondary prevention) and for two blood pressure ranges in primary prevention (stage one, 140-159/90-99 mm Hg; stage two, ≥160/≥100 mm Hg). Treatment of isolated systolic hypertension and combined systolic and diastolic hypertension were modeled as a reduction in systolic blood pressure; treatment of isolated diastolic hypertension was modeled as a reduction in diastolic blood pressure. One-way and probabilistic sensitivity analyses explored ranges of antihypertensive drug effectiveness and costs, monitoring frequency, medication adherence, side effect severity, background hypertension prevalence, antihypertensive medication treatment, case fatality, incidence and prevalence, and cardiovascular disease treatment costs. Median antihypertensive costs from Shanghai and Yunnan province were entered into the model in order to estimate the effects of very low and high drug prices. Incremental cost-effectiveness ratios less than the per capita gross domestic product of China (11,900 international dollars [Int$] in 2015) were considered cost-effective. Treating hypertensive adults with prior cardiovascular disease for secondary prevention was projected to be cost saving in the main simulation and 100% of probabilistic simulation results. Treating all hypertension for primary and secondary prevention would prevent about 800,000 cardiovascular disease events annually (95% uncertainty interval, 0.6 to 1.0 million) and was borderline cost-effective incremental to treating only cardiovascular disease and stage two patients (2015 Int$13,000 per QALY gained [95% uncertainty interval, Int$10,000 to Int$18,000]). Of all one-way sensitivity analyses, assuming adherence to taking medications as low as 25%, high Shanghai drug costs, or low medication efficacy led to the most unfavorable results (treating all hypertension, about Int$47,000, Int$37,000, and Int$27,000 per QALY were gained, respectively). The strengths of this study were the use of a recent Chinese national health survey, vital statistics, health care costs, and cohort study outcomes data as model inputs and reliance on clinical-trial-based estimates of coronary heart disease and stroke risk reduction due to antihypertensive medication treatment. The limitations of the study were the use of several sources of data, limited clinical trial evidence for medication effectiveness and harms in the youngest and oldest age groups, lack of information about geographic and ethnic subgroups, lack of specific information about indirect costs borne by patients, and uncertainty about the future epidemiology of cardiovascular diseases in China.

Conclusions: Expanded hypertension treatment has the potential to prevent about 800,000 cardiovascular disease events annually and be borderline cost-effective in China, provided low-cost essential antihypertensive medicines programs can be implemented.

No MeSH data available.


Related in: MedlinePlus