An expanded program of treatment for hypertension could prevent about 800,000 cardiovascular disease (CVD) events every year in China, according to a modeling study published this week in PLOS Medicine. The predictions of this simulation, reported by Andrew Moran of Columbia University and colleagues, indicate that such a program should also be borderline cost-effective, provided low cost essential anti-hypertensive drugs are used.
Hypertension is the leading cardiovascular risk factor in China, the world's most populous country. About 325 million adults in China have hypertension but less than half are aware of their condition, only 34% of Chinese adults with hypertension are treated with anti-hypertensive drugs, and only 28% of treated individuals achieve the target blood pressure of <140/90 mmHg.
Moran and colleagues used the Cardiovascular Disease Policy Model-China to simulate the costs of hypertension screening, provision of anti-hypertensive medications from China's national essential medicines list, monitoring, and the quality-adjusted life years (QALYs) gained by preventing CVD in Chinese adults with untreated hypertension through 2025. According to the model, treating the subgroup of patients with existing CVD was projected to be cost-saving. Treating hypertension in individuals with and without CVD would prevent between 600,000 and 1,000,000 (95% confidence intervals) CVD events annually, and be borderline cost-effective, at $10,000 to $18,000 (95% CIs; international dollars) per QALY gained.
Numerous assumptions, and data from a range of sources, were incorporated into the model and may limit the accuracy of these findings. Importantly, Moran and colleagues estimate that the cost-effectiveness of the intervention would be greatly reduced if adherence to treatment were lowered or drug costs were increased. The authors state, "Very few past studies have estimated the cost-effectiveness of hypertension treatment in China, and to our knowledge, ours is the first to assess cost-effectiveness by balancing program and intervention costs with projected downstream benefits of prevented CVD events."
Funding: AEM was supported by a Career Development Award (K08 HL089675-01A1) and a research grant (R01 HL107475-01) from the US National Heart, Lung, and Blood Institute. DG and CH were supported by grants from the Ministry of Science and Technology of China (2011BAI09B03 and 2011BAI11B03). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing Interests: The authors have declared that no competing interests exist.
Citation: Gu D, He J, Coxson PG, Rasmussen PW, Huang C, Thanataveerat A, et al. (2015) The Cost-Effectiveness of Low-Cost Essential Antihypertensive Medicines for Hypertension Control in China: A Modelling Study. PLoS Med 12(8): e1001860. doi:10.1371/journal.pmed.1001860
Department of Epidemiology, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
National Center for Cardiovascular Diseases, Beijing, China
Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana
Division of General Medicine, University of California at San Francisco, San Francisco, California
Division of General Medicine, Columbia University Medical Center, New York
School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
Department of Epidemiology, Capital Medical University Beijing Anzhen Hospital and Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
Columbia University College of Physicians and Surgeons, New York, New York, United States of America
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Andrew Moran, MD, MPH
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Dongfeng Gu, MD
Department of Epidemiology, Fuwai Hospital, Chinese Academy of Medical Sciences
and Peking Union Medical College,
National Center for Cardiovascular Diseases