The Cost-Effectiveness of Low-Cost Essential Antihypertensive Medicines for Hypertension Control in China: A Modelling Study

Abstract

BackgroundHypertension is China’s leading cardiovascular disease risk factor. Improved hypertension control in China would result in result in enormous health gains in the world’s largest population. A computer simulation model projected the cost-effectiveness of hypertension treatment in Chinese adults, assuming a range of essential medicines list drug costs.Methods and FindingsThe Cardiovascular Disease Policy Model-China, a Markov-style computer simulation model, simulated hypertension screening, essential medicines program implementation, hypertension control program administration, drug treatment and monitoring costs, disease-related costs, and quality-adjusted life years (QALYs) gained by preventing cardiovascular disease or lost because of drug side effects in untreated hypertensive adults aged 35–84 y over 2015–2025. Cost-effectiveness was assessed in cardiovascular disease patients (secondary prevention) and for two blood pressure ranges in primary prevention (stage one, 140–159/90–99 mm Hg; stage two, ≥160/≥100 mm Hg). Treatment of isolated systolic hypertension and combined systolic and diastolic hypertension were modeled as a reduction in systolic blood pressure; treatment of isolated diastolic hypertension was modeled as a reduction in diastolic blood pressure. One-way and probabilistic sensitivity analyses explored ranges of antihypertensive drug effectiveness and costs, monitoring frequency, medication adherence, side effect severity, background hypertension prevalence, antihypertensive medication treatment, case fatality, incidence and prevalence, and cardiovascular disease treatment costs. Median antihypertensive costs from Shanghai and Yunnan province were entered into the model in order to estimate the effects of very low and high drug prices. Incremental cost-effectiveness ratios less than the per capita gross domestic product of China (11,900 international dollars [Int$] in 2015) were considered cost-effective. Treating hypertensive adults with prior cardiovascular disease for secondary prevention was projected to be cost saving in the main simulation and 100% of probabilistic simulation results. Treating all hypertension for primary and secondary prevention would prevent about 800,000 cardiovascular disease events annually (95% uncertainty interval, 0.6 to 1.0 million) and was borderline cost-effective incremental to treating only cardiovascular disease and stage two patients (2015 Int$13,000 per QALY gained [95% uncertainty interval, Int$10,000 to Int$18,000]). Of all one-way sensitivity analyses, assuming adherence to taking medications as low as 25%, high Shanghai drug costs, or low medication efficacy led to the most unfavorable results (treating all hypertension, about Int$47,000, Int$37,000, and Int$27,000 per QALY were gained, respectively). The strengths of this study were the use of a recent Chinese national health survey, vital statistics, health care costs, and cohort study outcomes data as model inputs and reliance on clinical-trial-based estimates of coronary heart disease and s...

Hypertension; East and West

“…These estimates were remarkably shown to be consistent with a recent Indonesian survey that demonstrated 20-25% of all coronary heart diseases and 35-42% of all strokes were attributable to hypertension [5]. It is also worth remembering that effective control of hypertension has been shown to be highly cost effective in the West [6] and more recently in the East [7]. What lessons can we learn thus far and what can be done to mitigate this worrying state of affair?…”

“…This is further reaffirmed in a trial involving high risk hypertensives on treatment where a tighter control (achieved BP 122/64mmHg as compared to 135/74mmHg) produced a significant 43% in CV death, 30% reduction in heat failure, a 25% reduction in CV events and to top it all an impressive 27% reduction in all cause mortality [23]. Achieving BP control has been estimated to prevent up to 800,000 CV events yearly in China alone [7]. The need to achieve BP control especially among treated hypertensives cannot be over emphasized and the fact that we a struggling to achieve it in the East needs serious attention.…”

Effect of a Community Health Worker–Led Multicomponent Intervention on Blood Pressure Control in Low-Income Patients in Argentina

“…Therefore, the cost-effectiveness of this CHW-led multicomponent intervention for BP control could not be directly compared with other interventions for various conditions. 34 …”

Potential Cardiovascular and Total Mortality Benefits of Air Pollution Control in Urban China

“…This model has been used for CVD epidemiological projections and effectiveness analysis of specific policy interventions. 19 The urban-wide population for the years 2017-2030 was estimated using the projected total China population and urban-rural ratio from the World Urbanization Prospects (Supplemental Table S1). 11, 12 Means and proportions of CVD risk factors in urban Chinese adults aged 35 to 84 years were estimated from the China Cardiovascular Health Study and the China Multi-center Collaborative Study of Cardiovascular Epidemiology (ChinaMUCA).…”