Cost-effectiveness of Antihypertensive Medication: Exploring Race and Sex Differences Using Data From the REasons for Geographic and Racial Differences in Stroke Study

Abstract

Background: Antihypertensive medication decreases risk of cardiovascular disease (CVD) events in adults with hypertension. Although black adults have higher prevalence of hypertension and worse CVD outcomes compared with whites, limited attention has been given to the cost-effectiveness of antihypertensive medication for blacks.

Objective: To compare the cost-effectiveness of antihypertensive medication treatment versus no-treatment in white and black adults.

Research design: We constructed a State Transition Model to assess the costs and quality-adjusted life-years (QALYs) associated with either antihypertensive medication treatment or no-treatment using data from the REasons for Geographic and Racial Differences in Stroke (REGARDS) study and published literature. CVD events and health states considered in the model included stroke, coronary heart disease, heart failure, chronic kidney disease, and end-stage renal disease.

Subjects: White and black adults with hypertension in the United States, 45 years of age and above.

Measures: Yearly risk of CVD was determined using REGARDS data and published literature. Antihypertensive medication costs were determined using Medicare claims. Event and health state costs were estimated from published literature. All costs were adjusted to 2012 US dollars. Effectiveness was assessed using QALYs.

Results: Antihypertensive medication treatment was cost-saving and increased QALYs compared with no-treatment for white men ($7387; 1.14 QALYs), white women ($7796; 0.89 QALYs), black men ($8400; 1.66 QALYs), and black women ($10,249; 1.79 QALYs).

Conclusions: Antihypertensive medication treatment is cost-saving and increases QALYs for all groups considered in the model, particularly among black adults.

Figure 1

Simplified State Transition Model structure comparing the cost-effectiveness of hypertension treatment with antihypertensive medication versus no-treatment. A. shows a black women entering a decision tree to determine either treatment or no-treatment. Subsequently, the number of medications taken, for the treatment scenario, or the number of medications that should have been taken, for the no-treatment scenario, are assigned (Supplemental Methods). B. shows the markov node structure for the “treatment with 1 antihypertensive medication” branch. Once a participant suffers an event and enters a new health state, they remain in that health state until suffering another event or death. All markov nodes for treatment with 2, 3, or 4 or more antihypertensive medications as well as for the no-treatment branches are identical to the “treatment with 1” medication node. HTN=hypertension; TX=treatment; RX=prescription; CKD=chronic kidney disease; HF=heart failure; ESRD=end-stage renal disease; MI=myocardial infarction; QALYs=quality-adjusted life-years.