scholarly journals Applicability and cost-effectiveness of the Systolic Blood Pressure Intervention Trial (SPRINT) in the Chinese population: A cost-effectiveness modeling study

PLoS Medicine ◽  
2021 ◽  
Vol 18 (3) ◽  
pp. e1003515
Author(s):  
Chao Li ◽  
Kangyu Chen ◽  
Victoria Cornelius ◽  
Ewan Tomeny ◽  
Yang Wang ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cost Effectiveness ◽  
Systolic Blood Pressure ◽  
Standard Treatment ◽  
Cost Effective ◽  
Intensive Treatment ◽  
Adverse Event Rate ◽  
Intervention Trial ◽  
Chinese Adults ◽  
Life Years

Background The Systolic Blood Pressure Intervention Trial (SPRINT) showed significant reductions in death and cardiovascular disease (CVD) risk with a systolic blood pressure (SBP) goal of <120 mm Hg compared with a SBP goal of <140 mm Hg. Our study aimed to assess the applicability of SPRINT to Chinese adults. Additionally, we sought to predict the medical and economic implications of this intensive SBP treatment among those meeting SPRINT eligibility. Methods and findings We used nationally representative baseline data from the China Health and Retirement Longitudinal Study (CHARLS) (2011–2012) to estimate the prevalence and number of Chinese adults aged 45 years and older who meet SPRINT criteria. A validated microsimulation model was employed to project costs, clinical outcomes, and quality-adjusted life-years (QALYs) among SPRINT-eligible adults, under 2 alternative treatment strategies (SBP goal of <120 mm Hg [intensive treatment] and SBP goal of <140 mm Hg [standard treatment]). Overall, 22.2% met the SPRINT criteria, representing 116.2 (95% CI 107.5 to 124.8) million people in China. Of these, 66.4%, representing 77.2 (95% CI 69.3 to 85.0) million, were not being treated for hypertension, and 22.9%, representing 26.6 (95% CI 22.4 to 30.7) million, had a SBP between 130 and 139 mm Hg, yet were not taking antihypertensive medication. We estimated that over 5 years, compared to standard treatment, intensive treatment would reduce heart failure incidence by 0.84 (95% CI 0.42 to 1.25) million cases, reduce CVD deaths by 2.03 (95% CI 1.44 to 2.63) million cases, and save 3.84 (95% CI 1.53 to 6.34) million life-years. Estimated reductions of 0.069 (95% CI −0.28, 0.42) million myocardial infarction cases and 0.36 (95% CI −0.10, 0.82) million stroke cases were not statistically significant. Furthermore, over a lifetime, moving from standard to intensive treatment increased the mean QALYs from 9.51 to 9.87 (an increment of 0.38 [95% CI 0.13 to 0.71]), at a cost of Int$10,997 per QALY gained. Of all 1-way sensitivity analyses, high antihypertensive drug cost and lower treatment efficacy for CVD death resulted in the 2 most unfavorable results (Int$25,291 and Int$18,995 per QALY were gained, respectively). Simulation results indicated that intensive treatment could be cost-effective (82.8% probability of being below the willingness-to-pay threshold of Int$16,782 [1× GDP per capita in China in 2017]), with a lower probability in people with SBP 130–139 mm Hg (72.9%) but a higher probability among females (91.2%). Main limitations include lack of specific SPRINT eligibility information in the CHARLS survey, uncertainty about the implications of different blood pressure measurement techniques, the use of several sources of data with large reliance on findings from SPPRINT, limited information about the serious adverse event rate, and lack of information and evidence for medication effectiveness on renal disease. Conclusions Although adoption of the SPRINT treatment strategy would increase the number of Chinese adults requiring SBP treatment intensification, this approach has the potential to prevent CVD events, to produce gains in life-years, and to be cost-effective under common thresholds.

Abstract P176: Impact of Serious Adverse Event Risks on the Cost-effectiveness of Intensive Blood Pressure Goals in Patients Aged ≥75 Years

Circulation ◽  
2017 ◽  
Vol 135 (suppl_1) ◽  
Author(s):  
Natalia Ruiz-Negron ◽  
Brandon K Bellows ◽  
Adam P Bress ◽  
Jordan B King ◽  
Rachel Hess ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cost Effectiveness ◽  
Systolic Blood Pressure ◽  
Healthcare Costs ◽  
Older Patients ◽  
Cost Effective ◽  
Health State ◽  
Cvd Risk ◽  
Individual Patient Level ◽  
Life Years

Background: Compared to the overall Systolic Blood Pressure Intervention Trial (SPRINT) results, patients aged ≥75 years at baseline had a greater reduction in cardiovascular disease (CVD) events and all-cause mortality with an intensive systolic blood pressure (SBP) goal (<120 mmHg) compared to a standard SBP goal (<140 mmHg). Applying an intensive SBP goal in high-risk older patients represents a major shift in clinical practice and may increase concern for medication-related severe adverse events (SAEs). We hypothesized that the benefits of reduced CVD risk would outweigh the increased costs and SAE risk of intensive vs. standard SBP goals in SPRINT-eligible patients aged ≥75 years even when considering variable SAE risks. Methods: A microsimulation health-state transition model of 10,000 patients was created to estimate the CVD events, SAEs, quality-adjusted life years (QALYs), and direct healthcare costs of intensive vs. standard SBP goals. The model assumed patients were adherent to treatment during the median SPRINT follow-up, but that all patients would become non-adherent over 5 years. While adherent, CVD and SAE risks were derived from published SPRINT effect estimates for the ≥75 subgroup. Due to uncertainty in the SAE risk associated with intensive SBP goals in older adults, the intensive arm SAE risk was varied to determine the point at which treatment costs and harms outweighed CVD benefits at accepted willingness-to-pay thresholds. Healthcare costs and health state utilities were derived from national sources and other published estimates. Results: If SAE risk was equal to the observed rates in SPRINT, mean lifetime costs and QALYs were $268,000 and 7.85 for the intensive arm, and $262,000 and 7.60 for the standard arm. The resulting incremental cost-effectiveness ratio (ICER) was about $26,000 per QALY gained. However, as SAE risk in the intensive arm increased by 1.5, 2, and 2.5 times, the ICER increased to $33,000, $43,000, and $55,000 per QALY gained, respectively. Conclusion: Intensive SBP goals may be a cost-effective way to reduce CVD events and improve survival in patients aged ≥75 years, but safety and cost-effectiveness depend on medication-related SAE risk. However, these results are based on summary data and do not account for clustering of risks at the individual patient level. Thus, more precise prediction of risks and benefits is needed to guide selection of older patients for intensive SBP treatment goals.

Abstract WP396: Analysis of Patients With Excessively High Pre-Randomization Systolic Blood Pressure and Effect of Intensive Systolic Blood Pressure Reduction in Antihypertensive Treatment of Acute Cerebral Hemorrhage (ATACH) 2

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Adnan I Qureshi ◽  
Lydia D Foster ◽  
Iryna Lobanova ◽  
Wei Huang ◽  
Jose I Suarez ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Treatment Effect ◽  
Standard Treatment ◽  
Blood Pressure Reduction ◽  
Intensive Treatment ◽  
Hematoma Expansion ◽  
Disability Score ◽  
Modifying Effect ◽  
Current Guidelines

Background: Current guidelines recommend for intracerebral hemorrhage (ICH) patients with the systolic blood pressure (SBP) >220 mmHg, unlike those with initial SBP 150-220 mm, Hg, the efficacy of aggressive reduction of SBP is less well established and further studies are recommended. Methods: We analyzed data from ATACH 2 trial which randomized patients with initial SBP >180 mm Hg to intensive (goal 110-139 mmHg) and standard (goal 140-179 mmHg) SBP reduction using IV nicardipine within 4.5 hours of symptom onset. We compared the characteristics and outcomes between patients with pre- randomization SBP ≥220 mm Hg and those with initial SBP <220 mm Hg. We analyzed the modifying effect (interaction test) of pre-randomization SBP ≥220 mm Hg on treatment effect (intensive versus standard) on death or disability (score 4-6 on modified Rankin scale) at 3-months post-randomization ascertained by a blinded investigator. Results: Of 1000 randomized subjects, 48 subjects had a pre-randomization SBP ≥ 220 mm Hg (mean age 57.8 years, 65% men); 24 were assigned to intensive-treatment and standard-treatment each. The rate of death or disability at 3 months (47.9% versus 37.7%, odds ratio (OR): 1.52, 95% confidence interval (CI): 0.43 to 1.5, 0.85 to 2.72) and hematoma expansion within 24 hours (30.0% versus 21.2%, OR: 1.60; 95% CI: 0.80 to 3.20) was not different among subjects with SBP≥220 mm Hg SBP and those with SBP < 220 mm Hg. Rates of hematoma expansion (19% and 27.3%, OR: 0.63; 95% CI: 0.15 to 2.6) and neurological deterioration (8.7% versus 17.4%, OR: 0.45; 95% CI: 0.07 to 2.8) within 24 hours were not different between those randomized to intensive treatment and those to standard treatment in patients with SBP≥220 mm Hg. The interaction between initial SBP ≥220 mm Hg and treatment effect on death or disability was significant (p=0.0111). Conclusions: Patients with pre-randomization SBP ≥220 mm Hg did not have higher rates of hematoma expansion or death or disability compared to those with SBP <220 mm Hg. The interaction of pre- randomization SBP ≥220 mm Hg with the treatment effect and a non-significantly higher rate of death or disability associated with intensive treatment requires further studies.

scholarly journals Eligibility of the Systolic Blood Pressure Intervention Trial (SPRINT) to the Chinese Adults

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Liping Chen ◽  
Yiyan Zhang ◽  
Juan Jin ◽  
Nannan Li ◽  
Dan Liu ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Antihypertensive Medication ◽  
Population Based ◽  
Intervention Trial ◽  
Treatment Intensification ◽  
Chinese Adults ◽  
Eligibility Criteria ◽  
Cross Sectional ◽  
Framingham Risk

Objective. To explore the proportion and characteristic of Chinese adults meeting The Systolic Blood Pressure Intervention Trial (SPRINT) eligibility criteria and assess its generalizability. Method. Our study was based on a cross-sectional, population-based survey with a sample of 26,093 participants aged over 20 years. The SPRINT eligibility criteria were age ≥ 50 years, elevated SBP of 130 to 180 mmHg depending on the number of antihypertensive medication classes being taken, and increased cardiovascular disease (CVD) but without diabetes, history of stroke and estimated glomerular filtration rate < 20   ml / min / 1.73   m 2 , or receiving dialysis. Results. Overall, we estimated that 4,036 (15.5%) participants would meet the SPRINT eligibility criteria. They were generally older, likely to be female, lower educational level, tended to be more overweight, and had higher Framingham risk score compared with overall population or subjects aged ≥ 50 years. Of participants eligible for SPRINT, most (56.2%) of them were not treated for hypertension, and 542 (13.4%) were not previously considered to have hypertension or need for antihypertension therapy. Among the 11,637 adults with hypertension, 3,494 (30.0%) would potentially benefit from treatment intensification. The most common antihypertensive medication class being taken was diuretic agents. Conclusion. A substantial percentage of Chinese subjects meet the SPRINT eligibility criteria. Further studies are needed to assess the cost-effectiveness from treatment intensification in Chinese setting.

scholarly journals Cost-Effectiveness of Adding SGLT2 Inhibitors to Standard Treatment for Heart Failure With Reduced Ejection Fraction Patients in China

2021 ◽  
Vol 12 ◽  
Author(s):  
Yaohui Jiang ◽  
Rujie Zheng ◽  
Haiqiang Sang
Keyword(s):  
Heart Failure ◽  
Sensitivity Analysis ◽  
Cost Effectiveness ◽  
Ejection Fraction ◽  
Standard Treatment ◽  
Cost Effective ◽  
Old Patients ◽  
Reduced Ejection Fraction ◽  
Diabetes Status ◽  
Life Years

Objective: To evaluate the economics and effectiveness of adding dapagliflozin or empagliflozin to the standard treatment for heart failure (HF) for patients with reduced ejection fraction (HFrEF) in China.Methods: A Markov model was developed to project the clinical and economic outcomes of adding dapagliflozin or empagliflozin to the standard treatment for 66-year-old patients with HFrEF. A cost-utility analysis was performed based mostly on data from the empagliflozin outcome trial in patients with chronic heart failure and a reduced ejection fraction (EMPEROR-Reduced) study and the dapagliflozin and prevention of adverse outcomes in heart failure (DAPA-HF) trial. The primary outcomes were measured via total and incremental costs and quality-adjusted life years (QALYs) and the incremental cost-effectiveness ratio (ICER).Results: In China, compared to the standard treatment, although adding dapagliflozin to the standard treatment in the treatment of HFrEF was more expensive ($4,870.68 vs. $3,596.25), it was more cost-effective (3.87 QALYs vs. 3.64 QALYs), resulting in an ICER of $5,541.00 per QALY. Similarly, adding empagliflozin was more expensive ($5,021.93 vs. $4,118.86) but more cost-effective (3.66 QALYs vs. 3.53 QALYs), resulting in an ICER of $6,946.69 per QALY. A sensitivity analysis demonstrated the robustness of the model in identifying cardiovascular death as a significant driver of cost-effectiveness. A probabilistic sensitivity analysis indicated that when the willingness-to-pay was $11,008.07 per QALY, the probability of the addition of dapagliflozin or empagliflozin being cost-effective was 70.5 and 55.2%, respectively. A scenario analysis showed that the cost of hospitalization, diabetes status, and time horizon had a greater impact on ICER.Conclusion: Compared with standard treatments with or without empagliflozin, adding dapagliflozin to the standard treatment in the treatment of HFrEF in China was extremely cost-effective.

Heart Failure Events in a Clinical Trial on Arterial Hypertension: New Insights Into the SPRINT Trial

Hypertension ◽  
2021 ◽  
Vol 78 (5) ◽  
pp. 1241-1247
Author(s):  
Piotr Sobieraj ◽  
Peter M. Nilsson ◽  
Thomas Kahan
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Standard Treatment ◽  
Hazard Ratio ◽  
Intensive Treatment ◽  
Coronary Syndrome ◽  
End Point ◽  
Reduced Risk

SPRINT (Systolic Blood Pressure Intervention Trial) showed that intensive lowering of systolic blood pressure to <120 mm Hg was beneficial, as compared with standard treatment in which systolic blood pressure is lowered to <140 mm Hg. The proposal that the results of SPRINT were mainly driven by the reduction of heart failure events has undermined the main conclusion of the study. Therefore, this study aimed to assess whether the intensive treatment group was also associated with a reduced risk of cardiovascular events when heart failure events were excluded from the primary composite end point. The SPRINT data were analyzed with a redefined composite end point including myocardial infarction, acute coronary syndrome other than myocardial infarction, stroke, and cardiovascular death (excluding heart failure events). The results show that intensive treatment (<120 mm Hg) is associated with a reduced risk for the redefined composite end point (hazard ratio, 0.79 [95% CI, 0.66–0.95]; P =0.012), as compared with the standard treatment (<140 mm Hg), and with results similar to the original SPRINT findings (hazard ratio, 0.75 [95% CI, 0.64–0.89]; P <0.001). Overall, the main results of SPRINT are not driven by a reduction in heart failure events. Moreover, this post hoc analysis supports the use of a more intensive treatment strategy for high-risk hypertensive patients. Graphic Abstract: An online graphic abstract is available for this article.

Abstract 113: Beneficial or Harmful? The Role of Intensive Anti-hypertensive Treatment in the Development of Chronic Kidney Disease

Hypertension ◽  
2017 ◽  
Vol 70 (suppl_1) ◽  
Author(s):  
Ling Wang ◽  
Donna Wang
Keyword(s):  
Blood Pressure ◽  
Treatment Group ◽  
Systolic Blood Pressure ◽  
Standard Treatment ◽  
Intensive Treatment ◽  
Percent Reduction ◽  
Data Set ◽  
Treatment Target ◽  
Renal Outcomes ◽  
Standard Treatment Group

Hypertension is the leading cause of end-stage renal disease, and one of the goals of anti-hypertensive treatment is to protect the kidney. However, it is unknown how low of blood pressure as the treatment target should be so that anti-hypertensive therapy would not bring harm to patients especially for those already suffer from chronic kidney disease (CKD). Thus, we used the data set from The Systolic Blood Pressure Intervention Trial (SPRINT) to study the effect of lowering systolic blood pressure on renal disease development. The SPRINT data randomly assigned patients with a systolic blood pressure (SBP) of 130 mm Hg or higher to a SBP treatment target of less than 120 mm Hg (intensive treatment, n=4678) or a treatment target of less than 140 mm Hg (standard treatment, n=4683). We examined the effect of intensive treatment on six renal outcomes: 1) CKD composite, 2)50 percent reduction in eGFR, 3) dialysis 4) albuminuria, 5) 30 percent reduction in eGFR for patients with CKD at baseline (n=2646) and 6) albuminuria for patients without CKD at baseline (n=6715). Generalized Estimating Equation is used to account the correlation of blood pressure levels over time. At the end of year 1, the mean SBP was 121.4± 0.21 mm Hg in the intensive treatment group and 136.2± 0.21 mm Hg in the standard treatment group. The patients in intensive group were found to have a higher chance of 30% reduction of eGFR (OR=3.684, 95% CI= 2.51-5.40) than in standard treatment group. There was no difference between intensive and standard treatment groups for other 5 outcomes. In addition, 1 mm Hg elevation in SBP in patients with CDK at baseline significantly increased the chance of CKD composite (OR=1.03, 95% CI=1.01-1.04), the chance of 50 percent reduction in eGFR (OR=1.02, 95% CI=1.01-1.05), and chance of 30 percent reduction in eGFR (OR=1.02, 95% CI=1.01-1.02). Thus, SBP significantly correlated with renal outcomes in CKD patients. Our data show that five renal outcomes examined using SPRINT data set are not improved by intensive management of SBP in CKD patients, rather, patients received intensive management have a higher risk of eGFR reduction by 30%, which could be detrimental. Our study indicated that intensive SBP management should not be recommended to CKD patients.

Abstract P178: Cost-Effectiveness of Intensive versus Standard Blood Pressure Goals by Baseline Systolic Blood Pressure Levels in SPRINT-Eligible US Adults

Circulation ◽  
2017 ◽  
Vol 135 (suppl_1) ◽  
Author(s):  
Brandon K Bellows ◽  
Adam P Bress ◽  
Jordan B King ◽  
Natalia Ruiz-Negrón ◽  
Rachel Hess ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cost Effectiveness ◽  
Systolic Blood Pressure ◽  
Lifetime Cost ◽  
Model Parameters ◽  
Average Risk ◽  
Net Benefit ◽  
Cvd Risk ◽  
Serious Adverse Events ◽  
Life Years

Background: In high-risk adults, intensive systolic blood pressure (SBP) goals (<120 mmHg) reduced cardiovascular disease (CVD) events and mortality, when compared to standard SBP goals (<140 mmHg), in the Systolic Blood Pressure Intervention Trial (SPRINT). While average benefit of reduced CVD risk with intensive SBP goals outweighs the average risk of serious adverse events (SAEs) and treatment costs, net intensive SBP goal benefits may vary by baseline SBP. We hypothesized that intensive SBP goals would be cost-effective vs. standard SBP goals when stratified by baseline SBP level in SPRINT-eligible US adults from the payer’s perspective. Methods: Using CVD event, death, and SAE risks, a microsimulation model compared direct healthcare costs and quality-adjusted life-years (QALYs) in the SPRINT intensive and standard SBP goal arms over patients’ remaining lifetimes. Published literature and national estimates were used for model parameters. The model assumed that, after the planned duration of SPRINT, adherence to treatment goals decayed over time. To estimate the effect of baseline SBP on the cost-effectiveness of intensive SBP goals, baseline SBP was stratified into the following groups: 130-139 mmHg, 140-149 mmHg, 150-159 mmHg, 160-169 mmHg, and 170-180 mmHg. Results: With higher baseline SBP, patients in both arms experienced higher rates of CVD events or CVD deaths and accrued higher costs compared with patients starting with lower baseline SBP. However, with higher baseline SBP, there were slightly more incremental QALYs gained with intensive SBP treatment, from 0.29 to 0.31. This led to a modestly better incremental cost-effectiveness ratio (ICER) for intensive vs. standard SBP goals, decreasing from approximately $50,000 to $43,000 per QALY gained as baseline SBP increased. If SPRINT treatment effects and in-trial adherence persisted for the remaining lifetime, the ICER for intensive SBP goals decreased to approximately $25,000-$26,000 per QALY gained across baseline SBP groups. Conclusions: Treatment of all SPRINT-eligible patients led to lifetime cost-effectiveness below accepted willingness-to-pay thresholds and lifetime net benefit and cost-effectiveness varied only modestly by baseline SBP. However, this analysis was based on summary data and did not account for individual patient risks. Multiple predictors, in addition to baseline SBP, may be needed to identify which SPRINT-eligible patients derive maximal benefit from intensive SBP treatment.

scholarly journals Cost-effectiveness of pharmacist care for managing hypertension in Canada

2017 ◽  
Vol 150 (3) ◽  
pp. 184-197 ◽  
Author(s):  
Carlo Marra ◽  
Karissa Johnston ◽  
Valerie Santschi ◽  
Ross T. Tsuyuki
Keyword(s):  
Blood Pressure ◽  
Cost Effectiveness ◽  
Cost Saving ◽  
Systolic Blood Pressure ◽  
Blood Pressure Reduction ◽  
Cost Savings ◽  
Pharmacist Intervention ◽  
Pressure Reduction ◽  
Life Years ◽  
Pharmacist Care

Background: More than half of all heart disease and stroke are attributable to hypertension, which is associated with approximately 10% of direct medical costs globally. Clinical trial evidence has demonstrated that the benefits of pharmacist intervention, including education, consultation and/or prescribing, can help to reduce blood pressure; a recent Canadian trial found an 18.3 mmHg reduction in systolic blood pressure associated with pharmacist care and prescribing. The objective of this study was to evaluate the economic impact of such an intervention in a Canadian setting. Methods: A Markov cost-effectiveness model was developed to extrapolate potential differences in long-term cardiovascular and renal disease outcomes, using Framingham risk equations and other published risk equations. A range of values for systolic blood pressure reduction was considered (7.6-18.3 mmHg) to reflect the range of potential interventions and available evidence. The model incorporated health outcomes, costs and quality of life to estimate an overall incremental cost-effectiveness ratio. Costs considered included direct medical costs as well as the costs associated with implementing the pharmacist intervention strategy. Results: For a systolic blood pressure reduction of 18.3 mmHg, the estimated impact is 0.21 fewer cardiovascular events per person and, discounted at 5% per year, 0.3 additional life-years, 0.4 additional quality-adjusted life-years and $6,364 cost savings over a lifetime. Thus, the intervention is economically dominant, being both more effective and cost-saving relative to usual care. Discussion: Across a range of one-way and probabilistic sensitivity analyses of key parameters and assumptions, pharmacist intervention remained both effective and cost-saving. Conclusion: Comprehensive pharmacist care of hypertension, including patient education and prescribing, has the potential to offer both health benefits and cost savings to Canadians and, as such, has important public health implications.

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