Cost-Effectiveness of Hypertension Treatment According to 2017 American College of Cardiology and American Heart Association Guidelines

Abstract

Background: Compared with the 2003 Seventh Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC7) guideline, the 2017 American College of Cardiology and American Heart Association guideline (ACC/AHA 2017) expanded hypertension diagnostic criteria to blood pressure (BP) ≥130/80 mm Hg and intensified treatment goals to <130/80 mm Hg. The cost-effectiveness of ACC/AHA 2017 guideline treatment has not been quantified.

Methods: We used the Cardiovascular Disease (CVD) Policy Model to simulate hypertension treatment according to ACC/AHA 2017 compared with JNC7 in untreated US adults aged 35 to 79 years. Outcomes were projected over 10 years and included CVD events and deaths, quality-adjusted life-years (QALYs), and total health care costs (ie, costs of antihypertensive treatment and costs of health care utilization for cardiovascular and noncardiovascular care, regardless of payer). Cost-effectiveness was calculated from a health care sector perspective as incremental health care costs divided by incremental QALYs.

Results: Under ACC/AHA 2017, 4.9 million more US adults are indicated for treatment and 14.9 million are recommended more intensive treatment goals compared with JNC7. Over 10 years, ACC/AHA 2017 versus JNC7 treatment would cost $48 300 per QALY gained ($38 300/QALY in men; $65 200/QALY in women). Overall, 34% of CVD events prevented by ACC/AHA 2017 versus JNC7 would be from expanded diagnosis (at $120 900/QALY gained), and 66% from intensified BP treatment goals (at $18 900/QALY gained). Cost-effectiveness improved with a longer time horizon ($17 600 per QALY gained at 30 years) and when generic drug costs were assumed in place of median US drug costs ($27 900 per QALY gained in 10 years). ACC/AHA 2017 is cost-saving in adults with BP ≥140/90 mm Hg and prior CVD or 10-year CVD risk ≥10%.

Conclusions: Initiating hypertension treatment according to the ACC/AHA 2017 guideline in untreated US adults is cost-effective compared with JNC7 at 10 years. Prioritizing low-cost generic medicines and intensive BP treatment of high-CVD-risk adults with BP ≥140/90 mm Hg returns the most value.

Keywords: United States; adult; blood pressure; hypertension; policy.