Cost-effectiveness of a hypertension management programme in an elderly population: a Markov model

Abstract

BackgroundMounting evidence shows that multi-intervention programmes for hypertension treatment are more effective than an isolated pharmacological strategy. Full economic evaluations of hypertension management programmes are scarce and contain methodological limitations. The aim of the study was to evaluate if a hypertension management programme for elderly patients is cost-effective compared to usual care from the perspective of a third-party payer.MethodsWe built a cost-effectiveness model using published evidence of effectiveness of a comprehensive hypertension programme vs. usual care for patients 65 years or older at a community hospital in Buenos Aires, Argentina. We explored incremental cost-effectiveness between groups. The model used a life-time framework adopting a third-party payer's perspective. Incremental cost-effectiveness ratio (ICER) was calculated in International Dollars per life-year gained. We performed a probabilistic sensitivity analysis (PSA) to explore variable uncertainty.ResultsThe ICER for the base-case of the "Hypertension Programme" versus the "Usual care" approach was 1,124 International Dollars per life-year gained. PSA did not significantly influence results. The programme had a probability of 43% of being dominant (more effective and less costly) and, overall, 95% chance of being cost-effective.DiscussionResults showed that "Hypertension Programme" had high probabilities of being cost-effective under a wide range of scenarios. This is the first sound cost-effectiveness study to assess a comprehensive hypertension programme versus usual care. This study measures hard outcomes and explores robustness through a probabilistic sensitivity analysis.ConclusionsThe comprehensive hypertension programme had high probabilities of being cost-effective versus usual care. This study supports the idea that similar programmes could be the preferred strategy in countries and within health care systems where hypertension treatment for elderly patients is a standard practice.

Economic evaluation for first-line anti-hypertensive medicines: applications for the Philippines

“…The studies conducted at the sub-national level, primary care setting and health facility showed the cost-effectiveness of diuretics. Elsewhere it was described that comprehensive strategies for hypertension were cost-effective at the sub-national level [28,36]. Generalizing these recommendations for application at a Philippine local setting is predicted to produce savings.…”

The Importance of Model Structure in the Cost-Effectiveness Analysis of Primary Care Interventions for the Management of Hypertension

“…The most common initial state was diseasefree and the most common acute states modeled were stroke and MI followed by angina, HF, and CVD. Few studies modeled only a single health state to describe an acute cardiovascular event [36][37][38]. Some studies modeled additional states such as congestive HF [39], coronary artery disease [40], renal failure [41], or peripheral artery disease [42].…”

“…Some authors acknowledged they had excluded states [40,41] or combinations of health states (HF and stroke) [43] because of data limitations. Compared with the TASMIN-SR model, the review identified various model structures ranging from a simplistic approach (single CVD morbidity) [37,38,44] to more complex approaches (four states including stroke, MI, HF, and angina) [39,42,43].…”

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“…33–35 The International Physical Activity Questionnaire is used for physical activity, 34 and the 8-item Morisky Medication Adherence (MMAS) questionnaire is used for medication adherence. 35 …”