Abstract 24: From JNC 1 to JNC 8: Population Impact and Cost-Effectiveness of U.S. Hypertension Guidelines
The 2014 “JNC 8” hypertension guideline decreased the population eligible for treatment and altered blood pressure (BP) targets. We aimed to assess the public health impact and cost-effectiveness of implementing JNC 8 recommendations in the context of prior JNC guidelines.
Methods: Using the Cardiovascular Disease (CVD) Policy Model, we simulated CVD events and non-CVD deaths prevented, quality-adjusted life years (QALYs) gained, drug and monitoring costs incurred, and CVD treatment costs averted, if each JNC guideline were fully implemented in a population of untreated U.S. adults aged 35-74 years between 2014-2024. Incremental cost effectiveness ratios (ICER) were calculated as change in costs divided by change in QALYs. An ICER of <50,000 was considered cost effective. JNC guidelines were simplified into four periods based on treatment targets: JNC 1-3 (DBP <90 mmHg), JNC 4 (DBP < 90mmHg or isolated SBP <160mmHg), JNC 5-7 [<130/80 mmHg for diabetes and/or chronic kidney disease (CKD); BP <140/90 mmHg for all others] and JNC 8 (BP<140/90 mmHg for diabetes and/or CKD or <60 years old; BP <150/90mmHg for ≥60 years without diabetes or CKD).
Results: All JNC guidelines would be overall cost saving compared with no treatment (Table). Though JNC8 scaled back CVD prevention compared with its immediate predecessors, it would be the most cost saving guideline. Expanding from JNC 8 back to JNC 7 would be cost effective ($33,000 per QALY gained).
Discussion: We found that, if fully implemented today, all JNC guidelines would be cost saving compared to no treatment but that JNC 8 would be the most cost saving guideline to date. Under our assumptions, adding lower risk individuals eligible for treatment according to JNC 5-7 would still be a cost effective policy if JNC 8 could first be fully implemented. Further analyses will highlight evidence gaps by exploring uncertainty around the benefits of treating pre-hypertension in high risk patients and the balance of risks and benefits associated with treating older adults to a goal of 140/90 mmHg.
Author Disclosures: N. Moise: None. K. Tzong: None. L. Goldman: None. P. Coxson: None. K. Bibbins-Domingo: None. A. Moran: None.
- © 2015 by American Heart Association, Inc.