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Intensive BP control confers better patient outcomes, more cost-effective

When compared with standard BP control, intensive control of systolic BP prevented CVD events, extended life and did so at a lower cost than common willingness-to-pay thresholds, according to findings recently published in the New England Journal of Medicine.

The cost-effectiveness remained whether the benefits continued for a lifetime or reduced after 5 years, according to researchers.

“Intensive control may prevent cardiovascular disease events in high-risk patients and reduce health care costs, as compared with standard control, but these benefits must be weighed against the increased risk of serious adverse events and higher implementation costs (eg, additional office visits, laboratory tests, and medications),” Adam P. Bress, PharmD, of the department of population health sciences at the University of Utah School of Medicine and colleagues wrote.

Researchers performed a simulation study that applied SPRINT treatment effects and health care costs to a theoretical cohort of SPRINT-eligible adults. This model calculated lifetime costs of treatment and monitoring in patients with CVD, hypertension, and subsequent treatment costs; quality-adjusted life-years (QALYs) for intensive control vs. standard control of systolic BP; and treatment-related risks of serious adverse events and subsequent costs.

Bress and colleagues found that the mean number of QALYs would be 0.27 higher among patients who received intensive BP control, and would cost about $47,000 more per QALY gained if there were a cut back in compliance and treatment effects after 5 years. Further, the cost would be about $28,000 more per QALY gained if the treatment effects persisted for the rest of a patient’s life.

In addition, researchers wrote that the majority of the model’s results showed 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 continued for the rest of a patient’s life.

“Intensive control entailed more frequent office visits, laboratory tests, and greater medication use than did standard control, and such factors were costly early on,” Bress and colleagues wrote. “However, these costs were balanced by health gains from prevented cardiovascular disease events and deaths.”

Researchers estimated that the cost-effectiveness of the intensive BP control strategy would be fully seen after about 10 to 20 years of treatment. – by Janel Miller

Disclosure: Healio Family Medicine was unable to determine researchers’ relevant disclosures prior to publication.