Using thresholds based on risk of cardiovascular disease to target treatment for hypertension: modelling events averted and number treated

Baker, Shirley M.

doi:10.1136/bmj.320.7236.680

Cited by 44 publications

(26 citation statements)

References 21 publications

(14 reference statements)

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“…They have been shown in a model of coronary heart disease in New Zealand to predict fewer cardiovascular events than those based on a blood pressure level when applied to people with the same risk factors. 35 The present findings are consistent with the WHO CHOICE by Murray et al 7 : The absolute risk approach also had lower costeffectiveness ratios than the target-level approach. The present study extends their findings in 3 distinct ways.…”

Section: Discussionsupporting

confidence: 82%

Cost-Effectiveness Analysis of Hypertension Guidelines in South Africa

et al. 2005

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Background-Hypertension is responsible for more deaths worldwide than any other cardiovascular risk factor. Guidelines based on blood pressure level for initiation of treatment of hypertension may be too costly compared with an approach based on absolute cardiovascular disease (CVD) risk, especially in developing countries. Methods and Results-Using a Markov CVD model, we compared 6 strategies for initiation of drug treatment-2 different blood pressure levels (160/95 and 140/90 mm Hg) and 4 different levels of absolute CVD risk over 10 years (40%, 30%, 20%, and 15%)-with one of no treatment. We modeled a hypothetical cohort of all adults without CVD in South Africa, a multiethnic developing country, over 10 years. The incremental cost-effectiveness ratios for treating those with 10-year absolute risk for CVD Ͼ40%, 30%, 20%, and 15% were $700, $1600, $4900, and $11 000 per quality-adjusted life-year gained, respectively. Strategies based on a target blood pressure level were both more expensive and less effective than treatment decisions based on the strategy that used absolute CVD risk of Ͼ15%. Sensitivity analysis of cost of treatments, prevalence estimates of risk factors, and benefits expected from treatment did not change the ranking of the strategies. Conclusions-In South Africa, current guidelines based on blood pressure levels are both more expensive and less effective than guidelines based on absolute risk of cardiovascular disease. The use of quantitative risk-based guidelines for treatment of hypertension could free up major resources for other pressing needs, especially in developing countries.

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Section: Discussionsupporting

confidence: 82%

Cost-Effectiveness Analysis of Hypertension Guidelines in South Africa

et al. 2005

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“…On the other hand, the implementation of the total cardiovascular risk is more cost-effective, the cost-effectiveness increases as the threshold is raised [1,6,10,38e41]. For example, Baker et al [41] reports setting the threshold for treatment at a 5-year risk of disease of 20% leads to about a 10% net reduction in patients for whom drug treatment would be recommended; However, the total risk approach still averted almost 200 additional disease events over 5 years compared with single risk factors approach to treatment. These data are robust across several estimates of drug efficacy and of treatment costs [42].…”

Section: Discussionmentioning

confidence: 99%

“…Over the last decade, total risk assessment has been adopted by a variety of national and international guidelines, supporting the above thesis that management and treatment decisions should be based on total risk rather than on single risk factor approaches [33,34,41].…”

Section: Discussionmentioning

confidence: 99%

Total cardiovascular risk approach to improve efficiency of cardiovascular prevention in resource constrain settings

Mendis

Lindholm

Anderson

et al. 2011

Journal of Clinical Epidemiology

128

121

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“…For example, the use of desktop or computerised tools for predicting cardiovascular risk is well-established for targeting treatment in the General Practice setting. 27 However, such risk prediction tools are typically designed to support clinicians in making treatment decisions. As such, they tend to be disease-specific.…”

Section: Identifying High Risk Patientsmentioning

confidence: 99%

Predictive risk modelling in health: options for New Zealand and Australia

Panattoni¹,

Vaithianathan

Ashton³

et al. 2011

Aust. Health Review

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Abstract.Predictive risk models (PRMs) are case-finding tools that enable health care systems to identify patients at risk of expensive and potentially avoidable events such as emergency hospitalisation. Examples include the PARR (Patients-atRisk-of-Rehospitalisation) tool and Combined Predictive Model used by the National Health Service in England. When such models are coupled with an appropriate preventive intervention designed to avert the adverse event, they represent a useful strategy for improving the cost-effectiveness of preventive health care. This article reviews the current knowledge about PRMs and explores some of the issues surrounding the potential introduction of a PRM to a public health system. We make a particular case for New Zealand, but also consider issues that are relevant to Australia.

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Using thresholds based on risk of cardiovascular disease to target treatment for hypertension: modelling events averted and number treated

Abstract: Objective To estimate the impact of using thresholds based on absolute risk of cardiovascular disease to target drug treatment to lower blood pressure in the community.

Cited by 44 publications

References 21 publications

Cost-Effectiveness Analysis of Hypertension Guidelines in South Africa

Cost-Effectiveness Analysis of Hypertension Guidelines in South Africa

Total cardiovascular risk approach to improve efficiency of cardiovascular prevention in resource constrain settings

Predictive risk modelling in health: options for New Zealand and Australia

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