Effectiveness and Cost-Effectiveness of Blood Pressure Screening in Adolescents in the United States

Abstract

Objective To compare the long-term effectiveness and cost-effectiveness of 3 approaches to managing elevated blood pressure (BP) in adolescents in the United States: no intervention, “screen-and-treat,” and population-wide strategies to lower the entire BP distribution. Study design We used a simulation model to combine several data sources to project the lifetime costs and cardiovascular outcomes for a cohort of 15-year-old U.S. adolescents under different BP approaches and conducted cost-effectiveness analysis. We obtained BP distributions from the National Health and Nutrition Examination Survey 1999–2004 and used childhood-to-adult longitudinal correlation analyses to simulate the tracking of BP. We then used the coronary heart disease policy model to estimate lifetime coronary heart disease events, costs, and quality-adjusted life years (QALY). Results Among screen-and-treat strategies, finding and treating the adolescents at highest risk (eg, left ventricular hypertrophy) was most cost-effective ($18 000/QALY [boys] and $47 000/QALY [girls]). However, all screen-and-treat strategies were dominated by population-wide strategies such as salt reduction (cost-saving [boys] and $650/ QALY [girls]) and increasing physical education ($11 000/QALY [boys] and $35 000/QALY [girls]). Conclusions Routine adolescents BP screening is moderately effective, but population-based BP interventions with broader reach could potentially be less costly and more effective for early cardiovascular disease prevention and should be implemented in parallel.

Cost-Effectiveness Analysis of Screening for and Managing Identified Hypertension for Cardiovascular Disease Prevention in Vietnam

“…Several studies on screening for hypertension and treatment in populations at risk, because of history of CVD, high cholesterol, diabetes or age, have demonstrated the cost-effectiveness of this approach in preventing cardiovascular or kidney disease [7][8][9][10][11]. Although there are other risk factors for CVD such as diabetes and high cholesterol, high blood pressure (HBP) may be considered the logical first focus, with age and sex as obvious potentially key guiding factors to the hypertension risk.…”

Is Universal Pediatric Lipid Screening Justified?

“…A recent study of long-term effectiveness and cost-effectiveness of childhood blood pressure screening, for example, showed that compared with the population-wide policy approaches of reducing the salt content of food and promoting physical education, blood pressure screening—whether universal or selective—both costs more and is less effective. 6 …”

Cardiovascular risk among hypertensive adolescents and the potential benefit of a screen-and-treat strategy

“…Further, the NNT should be estimated based on results of clinical trials rather than derived from cohort studies [11]. Nevertheless, the small difference in the absolute risk and the very large NNT suggest at best a modest potential benefit of hypertension screening beginning in adolescence, which is consistent with the findings of a modeling study which showed only a modest costeffectiveness of blood pressure screen-and-treat strategies in adolescents for the prevention of CVD [14].…”