TY - JOUR
T1 - Cost-effectiveness analysis of different systolic blood pressure targets for people with a history of stroke or transient ischaemic attack
T2 - economic analysis of the PAST-BP (Prevention After Stroke – Blood Pressure) Study
AU - Penaloza, Maria Cristina
AU - Jowett, Sue
AU - Barton, Pelham
AU - Roalfe, Andrea
AU - Fletcher, Kate
AU - Taylor, Clare
AU - Hobbs, F. D. Richard
AU - McManus, Richard J
AU - Mant, Jonathan
PY - 2016/10/1
Y1 - 2016/10/1
N2 - Background: The PAST-BP trial found that using a lower systolic blood pressure (SBP) target (<130 mmHg or lower versus < 140mmHg) in a primary care population with prevalent cerebrovascular disease was associated with a small additional reduction in blood pressure (2.9 mmHg).
Objectives: To determine the cost effectiveness of an intensive systolic blood pressure target (<130mmHg or lower) compared with a standard target (<140mmHg) in people with a history of stroke or transient ischaemic attack
Perspective: UK National Health Service (NHS) and Personal Social Services (PSS)
Setting: People with a history of stroke or transient ischaemic attack (TIA) on general practice stroke/TIA registers in England.
Methods: A Markov model with a one year time cycle and a 30 year time horizon was used to estimate the cost per quality adjusted life year (QALY) of an intensive target versus a standard target. Individual patient level data were used from the PAST BP trial with regard to change in blood pressure and numbers of primary care consultations over a 12 month period. Published sources were used to estimate life expectancy, and risks of cardiovascular events and their associated costs and utilities.
Results: In the base-case results, aiming for an intensive blood pressure target was dominant, with the incremental lifetime costs being £169 lower per patient than for the standard blood pressure target with a 0.08 QALY gain. This was robust to sensitivity analyses, unless intensive blood pressure lowering reduced quality of life by 2% or more.
Conclusion: Aiming for a systolic blood pressure target of < 130mmHg or lower is cost effective in people who have had a stroke/TIA in the community, but it is difficult to separate out the impact of the lower target from the impact of more active management of blood pressure.
AB - Background: The PAST-BP trial found that using a lower systolic blood pressure (SBP) target (<130 mmHg or lower versus < 140mmHg) in a primary care population with prevalent cerebrovascular disease was associated with a small additional reduction in blood pressure (2.9 mmHg).
Objectives: To determine the cost effectiveness of an intensive systolic blood pressure target (<130mmHg or lower) compared with a standard target (<140mmHg) in people with a history of stroke or transient ischaemic attack
Perspective: UK National Health Service (NHS) and Personal Social Services (PSS)
Setting: People with a history of stroke or transient ischaemic attack (TIA) on general practice stroke/TIA registers in England.
Methods: A Markov model with a one year time cycle and a 30 year time horizon was used to estimate the cost per quality adjusted life year (QALY) of an intensive target versus a standard target. Individual patient level data were used from the PAST BP trial with regard to change in blood pressure and numbers of primary care consultations over a 12 month period. Published sources were used to estimate life expectancy, and risks of cardiovascular events and their associated costs and utilities.
Results: In the base-case results, aiming for an intensive blood pressure target was dominant, with the incremental lifetime costs being £169 lower per patient than for the standard blood pressure target with a 0.08 QALY gain. This was robust to sensitivity analyses, unless intensive blood pressure lowering reduced quality of life by 2% or more.
Conclusion: Aiming for a systolic blood pressure target of < 130mmHg or lower is cost effective in people who have had a stroke/TIA in the community, but it is difficult to separate out the impact of the lower target from the impact of more active management of blood pressure.
KW - Hypertension
KW - stroke
KW - transient ischaemic attack
KW - blood pressure target
KW - cost effectiveness
KW - decision model
KW - decision analysis
UR - https://www.scopus.com/pages/publications/84988424200
U2 - 10.1177/2047487316651982
DO - 10.1177/2047487316651982
M3 - Article
SN - 2047-4873
VL - 23
SP - 1590
EP - 1598
JO - European journal of preventive cardiology
JF - European journal of preventive cardiology
IS - 15
ER -
