Cost-effectiveness of antihypertensive deprescribing in primary care: a Markov modelling study using data from the OPTiMISE trial

Sue Jowett, Shay Kodabuckus, Gary A Ford, Richard Hobbs, Mark Lown, Jonathan Mant, Rupert Payne, Richard McManus, James Sheppard, OPTiMISE investigators

Research output: Contribution to journalArticlepeer-review

Abstract

Background:
Deprescribing of antihypertensive medications for older patients with normal blood pressure is recommended by some clinical guidelines, where the potential harms of treatment may outweigh the benefits. This study aimed to assess the cost-effectiveness of this approach.

Methods:
A Markov patient-level simulation was undertaken to model the effect of withdrawing one antihypertensive compared with usual care, over a life-time horizon. Model population characteristics were estimated using data from the OPTiMISE antihypertensive deprescribing trial, and the effects of blood pressure changes on outcomes were derived from the literature. Health-related quality of life was modeled in Quality-Adjusted Life Years (QALYs) and presented as costs per QALY gained.

Results:
In the base-case analysis, medication reduction resulted in lower costs than usual care (mean difference £185), but also lower QALYs (mean difference 0.062) per patient over a life-time horizon. Usual care was cost-effective at £2975 per QALY gained (more costly, but more effective). Medication reduction resulted more heart failure and stroke/TIA events but fewer adverse events. Medication reduction may be the preferred strategy at a willingness-to-pay of £20 000/QALY, where the baseline absolute risk of serious drug-related adverse events was ≥7.7% a year (compared with 1.7% in the base-case).

Conclusions:
Although there was uncertainty around many of the assumptions underpinning this model, these findings suggest that antihypertensive medication reduction should not be attempted in many older patients with controlled systolic blood pressure. For populations at high risk of adverse effects, deprescribing may be beneficial, but a targeted approach would be required in routine practice.
Original languageEnglish
Number of pages10
JournalHypertension
Early online date10 Mar 2022
DOIs
Publication statusPublished - May 2022

Bibliographical note

VoR not yet published as of 15/03/2022.

Keywords

  • hypertension
  • blood pressure
  • heart failure
  • quality of life
  • cardiovascular disease

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