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: a simulation modeling study

• Published in: Hypertension research Vol. 46; no. 1; pp. 187 - 199
• Main Authors: Liao, Chia-Te, Toh, Han Siong, Yang, Chun-Ting, Hsu, Chien-Yi, Lee, Mei-Chuan, Chang, Wei-Ting, Chen, Zhih-Cherng, Chang, Hung-Yu, Strong, Carol
• Format: Journal Article
• Language: English
• Published: England Nature Publishing Group 01.01.2023
• Subjects: Blood Pressure; Cardiology; Clinical practice guidelines; Cost analysis; Cost-Benefit Analysis; Health economics; Health risks; Humans; Hypertension; Hypertension - drug therapy; Markov chains; Preventive medicine; Taiwan; Taiwan; Hypertension; Intensive blood-pressure control; Taiwan Society of Cardiology; Cost-effectiveness; Guidelines
• ISSN: 0916-9636; 1348-4214
• DOI: 10.1038/s41440-022-01037-5

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.