Abstract P013: Cost-Effectiveness of Treating Hypertension in African Americans According to 2014 Guidelines
Background: Among U.S. ethnic groups, African Americans have the highest prevalence of hypertension and higher rates of hypertension-related morbidity and mortality. We estimated the cost-effectiveness of improved hypertension control in African Americans.
Methods: The populations studied were African Americans and all U.S. adults aged 35-74 years. Using the CVD Policy Model, we simulated CVD events and non-CVD deaths, quality-adjusted life years (QALYs), and hypertension and CVD treatment costs, before and after implementing 2014 U.S. guidelines. African American and overall U.S. CVD incidence, mortality, and risk factor levels were obtained from cohort studies, vital statistics, and the NHANES. Hypertension treatment effects were derived from a meta-analysis of clinical trials. Stage 2 hypertension was defined as BP ≥160/100 mmHg; stage 1 as BP ≥140/90 and <160/100 mmHg. Incremental cost-effectiveness ratios (ICERs) were calculated as change in costs divided by change in QALYs. An ICER <50,000 was cost effective, ≥$50,000 and <$150,000 intermediate value, and >$150,000 low value.
Results: Treating hypertension in CVD patients and in stage 2 hypertensives without CVD would be cost-saving in all African Americans and in all but the youngest women overall (Table). Treating stage 1 hypertension would be cost-saving in all African American men except for ages 35-44 without diabetes or CKD, and cost-saving in all women ≥45 years old. Treating the youngest women with stage 1 hypertension was of intermediate or low value in both African Americans and the U.S. overall, but of more value in African American women.
Discussion: In a computer simulation of hypertension treatment according to 2014 guidelines, we found that controlling hypertension would be cost-saving in all African American adults age 45 or older. These results suggest that investment in effective clinic and community-based interventions aimed at controlling hypertension in African Americans would yield high value to health system payers and to society.
Author Disclosures: E. Vasudeva: B. Research Grant; Modest; NIH T35 student fellowship. N. Moise: B. Research Grant; Modest; HRSA training grant (T32HP10260),. K.Y. Tzong: None. J. Penko: None. L. Goldman: B. Research Grant; Modest; NHLBI R01 (R01 HL107475). P.G. Coxson: None. K. Bibbins-Domingo: B. Research Grant; Significant; NINDS project grant (U54NS081760). G. Consultant/Advisory Board; Modest; member of the United States Preventive Services Task Force (USPSTF) and current co-Vice Chair. A.E. Moran: B. Research Grant; Significant; NHLBI R01 (R01 HL107475), AHA Founder's Clinical Research Program (10CRP4140089).
This research has received full or partial funding support from the American Heart Association, Founders Affiliate (Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, Rhode Island, Vermont).
- © 2015 by American Heart Association, Inc.