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Cited by 284

The DOI matches its Crossref record; 11 of the 11 references it cites were found in a registry or an index.

Cost-Effectiveness of Intensive versus Standard Blood-Pressure Control

Open access
Bress, Adam P., Bellows, Brandon K., King, Jordan B., Hess, Rachel, Beddhu, Srinivasan, Zhang, Zugui, Berlowitz, Dan R., Conroy, Molly B., Fine, Larry, Oparil, Suzanne, Morisky, Donald E., Kazis, Lewis E., Ruiz-Negrón, Natalia, Powell, Jamie, Tamariz, Leonardo, Whittle, Jeff, Wright, Jackson T., Supiano, Mark A., Cheung, Alfred K., Weintraub, William S., Moran, Andrew E.·2017·New England Journal of Medicine
DOI 10.1056/nejmsa1616035
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Abstract

BACKGROUND: In the Systolic Blood Pressure Intervention Trial (SPRINT), adults at high risk for cardiovascular disease who received intensive systolic blood-pressure control (target, <120 mm Hg) had significantly lower rates of death and cardiovascular disease events than did those who received standard control (target, <140 mm Hg). On the basis of these data, we wanted to determine the lifetime health benefits and health care costs associated with intensive control versus standard control. METHODS: We used a microsimulation model to apply SPRINT treatment effects and health care costs from national sources to a hypothetical cohort of SPRINT-eligible adults. The model projected lifetime costs of treatment and monitoring in patients with hypertension, cardiovascular disease events and subsequent treatment costs, treatment-related risks of serious adverse events and subsequent costs, and quality-adjusted life-years (QALYs) for intensive control versus standard control of systolic blood pressure. RESULTS: We determined that the mean number of QALYs would be 0.27 higher among patients who received intensive control than among those who received standard control and would cost approximately $47,000 more per QALY gained if there were a reduction in adherence and treatment effects after 5 years; the cost would be approximately $28,000 more per QALY gained if the treatment effects persisted for the remaining lifetime of the patient. Most simulation results indicated that intensive treatment would be cost-effective (51 to 79% below the willingness-to-pay threshold of $50,000 per QALY and 76 to 93% below the threshold of $100,000 per QALY), regardless of whether treatment effects were reduced after 5 years or persisted for the remaining lifetime. CONCLUSIONS: In this simulation study, intensive systolic blood-pressure control prevented cardiovascular disease events and prolonged life and did so at levels below common willingness-to-pay thresholds per QALY, regardless of whether benefits were reduced after 5 years or persisted for the patient's remaining lifetime. (Funded by the National Heart, Lung, and Blood Institute and others; SPRINT ClinicalTrials.gov number, NCT01206062 .).

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Metadata

Authors
Bress, A. P., Bellows, B. K., King, J. B., Hess, R., Beddhu, S., Zhang, Z., Berlowitz, D. R., Conroy, M. B., Fine, L., Oparil, S., Morisky, D. E., Kazis, L. E., Ruiz-Negrón, N., Powell, J., Tamariz, L., Whittle, J., Wright, J. T., Supiano, M. A., Cheung, A. K., Weintraub, W. S., & Moran, A. E.
Venue
New England Journal of Medicine
Publisher
Massachusetts Medical Society
Published
2017-08-24
Volume
377
Issue
8
Pages
745-755
ISSN
  • 0028-4793 (ISSN-L)
  • 1533-4406
DOI
10.1056/nejmsa1616035
OpenAlex
W2749174827
Cited by
284
References
11
FWCI
11.60
Type
journal article
Language
en
Open access
bronze

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