TY - JOUR
T1 - Economic evaluation of new blood pressure target for hypertensive patients in Taiwan according to the 2022 hypertension clinical practice guidelines of the Taiwan society of cardiology
T2 - a simulation modeling study
AU - Liao, Chia Te
AU - Toh, Han Siong
AU - Yang, Chun Ting
AU - Hsu, Chien Yi
AU - Lee, Mei Chuan
AU - Chang, Wei Ting
AU - Chen, Zhih Cherng
AU - Chang, Hung Yu
AU - Strong, Carol
N1 - Funding Information:
The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: this project was supported by a grant to Chia-Te Liao from the Ministry of Science and Technology in Taiwan (MOST 111–2917-I-006–007 and MOST 111–2314-B-384-003), and Chi Mei Medical Center (CMHCR11003).
Funding Information:
CTL drafted the manuscript. CTL, HST, CTY and CYH contributed to this study, including the conception and design of the research. CTL, WTC and HYC contributed to this study’s data extraction, analyses, and interpretation of data. This manuscript was revised by HST, WTC, ZCC, and CS. All authors gave final approval and agree to all aspects of the work, ensuring integrity and accuracy. We appreciated the supports of Professor Zhen-Yu Zhang, Dongmei Wei and Jesus Melgarejo from KU Leuven.
Publisher Copyright:
© 2022, The Author(s), under exclusive licence to The Japanese Society of Hypertension.
PY - 2023/1
Y1 - 2023/1
N2 - With the promising cardiovascular benefits in the STEP and SPRINT trials, the 2022 Taiwan’s hypertension guidelines redefined the hypertension threshold as 130/80 mmHg and a universal blood-pressure target of <130/80 mmHg. This study’s objective was to examine the cost-effectiveness of the intensive blood-pressure target for hypertensive patients using estimated lifetime medical costs and quality-adjusted life years (QALY) from the Taiwan national payer’s perspective. We developed a lifetime Markov model comparing the intensive and conservative blood-pressure targets. Incremental cost-effectiveness ratio (ICER) against the willing-to-pay thresholds at the one-time [US$34,000(NT$1,020,000)] and three-time [US$100,000(NT$3,000,000)] gross domestic product per capita were defined as very cost-effect and only cost-effective. The cost-effectiveness in different age stratifications and cardiovascular risks treated with a more intensive target (120 mmHg) were examined in the subgroup analyses. The new blood-pressure treatment target produced more lifetime medical costs [US$31,589(NT$947,670) versus US$26,788(NT$803,640)] and QALYs (12.54 versus 12.25), and the ICER was US$16,589(NT$497,670), which was 99.1% and 100% probability of a very cost-effective and cost-effective strategy. The ICERs in all age stratifications had more than a 90% probability of being very cost-effective, and ICERs decreased with age. More intensive control in patients with high cardiovascular risks produced a lower ICER [US$14,547(NT$436,410)]. In conclusion, Taiwan’s new blood-pressure treatment target can prevent more cardiovascular events with acceptable costs per QALY below the willing-to-pay thresholds. The cost-effectiveness of intensive control is consistent across different ages and more pronounced with the increase in age and cardiovascular risk.
AB - With the promising cardiovascular benefits in the STEP and SPRINT trials, the 2022 Taiwan’s hypertension guidelines redefined the hypertension threshold as 130/80 mmHg and a universal blood-pressure target of <130/80 mmHg. This study’s objective was to examine the cost-effectiveness of the intensive blood-pressure target for hypertensive patients using estimated lifetime medical costs and quality-adjusted life years (QALY) from the Taiwan national payer’s perspective. We developed a lifetime Markov model comparing the intensive and conservative blood-pressure targets. Incremental cost-effectiveness ratio (ICER) against the willing-to-pay thresholds at the one-time [US$34,000(NT$1,020,000)] and three-time [US$100,000(NT$3,000,000)] gross domestic product per capita were defined as very cost-effect and only cost-effective. The cost-effectiveness in different age stratifications and cardiovascular risks treated with a more intensive target (120 mmHg) were examined in the subgroup analyses. The new blood-pressure treatment target produced more lifetime medical costs [US$31,589(NT$947,670) versus US$26,788(NT$803,640)] and QALYs (12.54 versus 12.25), and the ICER was US$16,589(NT$497,670), which was 99.1% and 100% probability of a very cost-effective and cost-effective strategy. The ICERs in all age stratifications had more than a 90% probability of being very cost-effective, and ICERs decreased with age. More intensive control in patients with high cardiovascular risks produced a lower ICER [US$14,547(NT$436,410)]. In conclusion, Taiwan’s new blood-pressure treatment target can prevent more cardiovascular events with acceptable costs per QALY below the willing-to-pay thresholds. The cost-effectiveness of intensive control is consistent across different ages and more pronounced with the increase in age and cardiovascular risk.
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U2 - 10.1038/s41440-022-01037-5
DO - 10.1038/s41440-022-01037-5
M3 - Article
C2 - 36229527
AN - SCOPUS:85139831173
SN - 0916-9636
VL - 46
SP - 187
EP - 199
JO - Hypertension Research
JF - Hypertension Research
IS - 1
ER -