Objectives The aim of this study was to evaluate the cost effectiveness of ambulatory blood pressure monitoring (ABPM) compared with home blood pressure monitoring (HBPM) and clinic blood pressure monitoring (CBPM) in diagnosing hypertension in Australia. Methods A cohort-based Markov model was built from the Payer's perspective (Australian government) comparing lifetime costs and effectiveness of ABPM, HBPM and CBPM in people aged ≥ 35 years with suspected hypertension who have a CBPM between ≥ 140/90 mmHg and ≤ 180/110 mmHg using a sphygmomanometer and have not yet commenced antihypertensive treatment. The main outcome measures were incremental cost-effectiveness ratio (ICER) assessing cost per quality-adjusted life-year (QALY) and life-years (LYs) gained by ABPM versus HBPM and CBPM.
Background
Individuals with chronic kidney disease (CKD) are at very high risk for atherosclerotic cardiovascular disease (ASCVD). New lipid lowering agents offer hope of improved outcomes where traditional agents have been less efficacious, yet the cost of these agents need consideration in this population before their widespread application.
Objective
We sought to evaluate the cost effectiveness of novel lipid lowering therapies for a CKD population.
Methods
We searched four electronic databases, one government registry, and the reference lists of included literature to identify cost-effectiveness analyses of novel lipid lowering agents in CKD. Costs were converted to a single currency to allow cross-country comparisons. Completeness of reporting was analysed using the CHEERS checklist. Results were synthesised in narrative form with graphical representation of cost effectiveness ratios.
Results
Of the 1041 identified studies, four met inclusion criteria. None were specific to a CKD-only population. All examined the impact of proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) in the secondary prevention of ASCVD. Incremental cost-effectiveness ratios of new agents compared with standard care were between €7,288 and €112,530 per quality adjusted life year (QALY) gained. Cost-effectiveness was sensitive to the degree of cardiovascular risk of the underlying populations.
Conclusion
This review found PCSK9i were moderately cost effective in populations with high cardiovascular risk. People with CKD were included as an undifferentiated subpopulation in the primary studies but application of these findings to CKD-specific populations should be interpreted with caution. There is insufficient evidence for a health economic case to support novel lipid lowering therapies for advanced CKD.
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