Alternative Strategies to Achieve Cardiovascular Mortality Goals in China and India: A Microsimulation of Target-Versus Risk-Based Blood Pressure Treatment
Background—The World Health Organization (WHO) aims to reduce mortality from chronic diseases including cardiovascular disease (CVD) by 25% by 2025. High blood pressure (BP) is a leading CVD risk factor. We sought to compare three strategies for treating BP in China and India: a treat-to-target (TTT) strategy emphasizing lowering BP to a target, a benefit-based tailored treatment (BTT) strategy emphasizing lowering CVD risk, or a hybrid strategy currently recommended by the WHO.
Methods and Results—We developed a microsimulation model of adults aged 30-70 years old in China and in India to compare the two treatment approaches across a 10-year policy-planning horizon. In the model, a BTT strategy treating adults with a 10-year CVD event risk >10% used similar financial resources but averted about 5 million more DALYs in both China and India than a TTT approach based on current U.S. guidelines. The hybrid strategy in current WHO guidelines produced no substantial benefits over TTT. BTT was more cost-effective at $205-$272/ DALY averted, which was $142-$182 less per DALY than TTT or hybrid strategies. The comparative effectiveness of BTT was robust to uncertainties in CVD risk estimation or to variations in the age range analyzed, the BTT treatment threshold, or rates of treatment access, adherence, or concurrent statin therapy.
Conclusions—In model-based analyses, a simple BTT strategy was more effective and cost-effective than TTT or hybrid strategies in reducing mortality.
- acute myocardial infarction
- chronic ischemic heart disease
- cerebrovascular disease/stroke
- health policy and outcome research
- Received October 19, 2015.
- Revision received December 17, 2015.
- Accepted December 29, 2015.