Cost-effectiveness analysis of different systolic blood pressure targets for people with a history of stroke or transient ischaemic attack: economic analysis of the PAST-BP (Prevention After Stroke – Blood Pressure) Study

Research output: Contribution to journalArticle

Authors

  • Kate Fletcher
  • F. D. Richard Hobbs
  • Richard J McManus
  • Jonathan Mant

Colleges, School and Institutes

External organisations

  • University of Cambridge
  • University of Oxford
  • Nuffield Department of Primary Care Health Sciences
  • NIHR School for Primary Care Research

Abstract

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.

Details

Original languageEnglish
Pages (from-to)1590-1598
JournalEuropean journal of preventive cardiology
Volume23
Issue number15
Early online date25 May 2016
Publication statusPublished - 1 Oct 2016

Keywords

  • Hypertension , stroke , transient ischaemic attack, blood pressure target, cost effectiveness, decision model, decision analysis