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Economic evaluation of primary prevention of cardiovascular diseases in mild hypertension: a scenario analysis for the Netherlands.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Stevanovic, Jelena O'Prinsen, Anouk C. Verheggen, Bram G. Schuiling-Veninga, Nynke Postma, Maarten J. Pechlivanoglou, Petros
Spatial Coverage	Netherlands
Description	Author Affiliation: Stevanovic J ( Unit of Pharmacoepidemiology and Pharmacoecononics, Department of Pharmacy, University of Groningen, Groningen, the Netherlands. Electronic address: j.stevanovic@rug.nl.); O'Prinsen AC ( Sanofi, Gouda, the Netherlands.); Verheggen BG ( Pharmerit, Rotterdam, the Netherlands.); Schuiling-Veninga N ( Unit of Pharmacoepidemiology and Pharmacoecononics, Department of Pharmacy, University of Groningen, Groningen, the Netherlands.); Postma MJ ( Unit of Pharmacoepidemiology and Pharmacoecononics, Department of Pharmacy, University of Groningen, Groningen, the Netherlands.); Pechlivanoglou P ( Toronto Health Economics and Technology Assessment, Toronto, Ontario, Canada)
Abstract	BACKGROUND: In the Netherlands, antihypertensive treatment for patients with mild hypertension is recommended if the 10-year cardiovascular disease (CVD) risk exceeds 20%. Recent evidence suggests that lifelong CVD risk estimates might be more informative than 10-year ones. In addition, the cost of antihypertensive treatment in the Netherlands has decreased during the last decade. OBJECTIVE: The aim of this study is to estimate the cost-effectiveness of lowering systolic blood pressure (SBP) in patients ineligible for treatment in both a 10-year and a lifetime horizon. METHODS: A Markov model was developed to assess the cost-effectiveness of SBP reduction compared with no reduction in patients with mild hypertension and low CVD risk. Modified SCORE (Systematic Coronary Risk Evaluation) risk estimates were used to predict fatal and nonfatal CVD events. We analyzed scenarios for different age groups, sexes, and SBP reductions. Specifically, SBP reductions due to hydrochlorothiazide (HCT) 25 mg and hypothetical reductions with HCT 12.5 mg-losartan 50 mg combination were assumed. Parameter uncertainty was assessed through a probabilistic sensitivity analysis. RESULTS: In a 10-year horizon, in scenarios of SBP reduction with HCT 25 mg, the incremental cost-effectiveness ratio (ICER) estimates for men varied across different ages in the range of 6032 to 58,217 per life-year gained, whereas for women ICER estimates were in the range of 12,345 to 361,064 per life-year gained. In a lifetime horizon, the cost-effectiveness estimates were favorable for both sexes. In scenarios of hypothetical SBP reductions, more favorable ICER estimates compared with no reduction were found. A large uncertainty around the cost-effectiveness estimates was observed among all scenarios. CONCLUSION: Larger SBP reductions were found to be cost-effective in both a 10-year and lifetime horizon. These findings might call for more aggressive SBP reductions in patients with mild hypertension. However, a high level of uncertainty surrounds these cost-effectiveness estimates because they are based on CVD risk prediction modeling.
File Format	HTM / HTML
ISSN	01492918
Issue Number	3
Volume Number	36
e-ISSN	1879114X
Journal	Clinical Therapeutics
Language	English
Publisher	Elsevier
Publisher Date	2014-03-01
Publisher Place	United States
Access Restriction	One Nation One Subscription (ONOS)
Subject Keyword	Discipline Pharmacology Cardiovascular Diseases Economics Prevention & Control Cost-benefit Analysis Hypertension Primary Prevention Adult Aged Aged, 80 And Over Antihypertensive Agents Therapeutic Use Blood Pressure Drug Effects Drug Combinations Female Humans Hydrochlorothiazide Drug Therapy Losartan Male Markov Chains Middle Aged Netherlands Risk Factors Smoking Adverse Effects Journal Article Research Support, Non-u.s. Gov't
Content Type	Text
Resource Type	Article
Subject	Pharmacology Pharmacology (medical)

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