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. 2023 Jun 15;13(6):1001.
doi: 10.3390/jpm13061001.

Cost-Effectiveness Analysis of Personalized Hypertension Prevention

Sen-Te Wang  1   2 , Ting-Yu Lin  3 , Tony Hsiu-Hsi Chen  3 , Sam Li-Sheng Chen  4 , Jean Ching-Yuan Fann  5
Affiliations

Cost-Effectiveness Analysis of Personalized Hypertension Prevention

Sen-Te Wang et al. J Pers Med. .

Abstract

Background: While a population-wide strategy involving lifestyle changes and a high-risk strategy involving pharmacological interventions have been described, the recently proposed personalized medicine approach combining both strategies for the prevention of hypertension has increasingly gained attention. However, a cost-effectiveness analysis has been hardly addressed. This study was set out to build a Markov analytical decision model with a variety of prevention strategies in order to conduct an economic analysis for tailored preventative methods.

Methods: The Markov decision model was used to perform an economic analysis of four preventative strategies: usual care, a population-based universal approach, a population-based high-risk approach, and a personalized strategy. In all decisions, the cohort in each prevention method was tracked throughout time to clarify the four-state model-based natural history of hypertension. Utilizing the Monte Carlo simulation, a probabilistic cost-effectiveness analysis was carried out. The incremental cost-effectiveness ratio was calculated to estimate the additional cost to save an additional life year.

Results: The incremental cost-effectiveness ratios (ICER) for the personalized preventive strategy versus those for standard care were -USD 3317 per QALY gained, whereas they were, respectively, USD 120,781 and USD 53,223 per Quality-Adjusted Life Year (QALY) gained for the population-wide universal approach and the population-based high-risk approach. When the ceiling ratio of willingness to pay was USD 300,000, the probability of being cost-effective reached 74% for the universal approach and was almost certain for the personalized preventive strategy. The equivalent analysis for the personalized strategy against a general plan showed that the former was still cost-effective.

Conclusions: To support a health economic decision model for the financial evaluation of hypertension preventative measures, a personalized four-state natural history of hypertension model was created. The personalized preventive treatment appeared more cost-effective than population-based conventional care. These findings are extremely valuable for making hypertension-based health decisions based on precise preventive medication.

Keywords: cost-effectiveness analysis; hypertension; personalized prevention.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Study framework of the economic appraisal of the prevention of hypertension carried out in this work.
Figure 2
Figure 2
Markov decision tree for the cost-effectiveness of hypertension prevention. (a) The part of nature history of acute myocardial infarction. (b) The part of nature history of stroke.
Figure 3
Figure 3
The four-stage hypertension progression with the four intervention strategies. The color indicates the disease risk from low to high.
Figure 4
Figure 4
The scatter incremental cost effectiveness plot for hypertension prevention. (A) Population-wide approach vs. usual care (B) High-risk group approach vs- usual care (C) Personalized approach vs. usual care.
Figure 5
Figure 5
The acceptability curve for hypertension prevention. (A) Population-wide approach vs. usual care (B) High-risk group approach vs. usual care (C) Personalized approach vs. usual care.
See this image and copyright information in PMC

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