Economic evaluation of new blood pressure target for hypertensive patients in Taiwan according to the 2022 hypertension clinical practice guidelines of the Taiwan society of cardiology: a simulation modeling study

Chia-Te Liao; Han Siong Toh; Chun-Ting Yang; Chien-Yi Hsu; Mei-Chuan Lee; Wei-Ting Chang; Zhih-Cherng Chen; Hung-Yu Chang; Carol Strong

doi:10.1038/s41440-022-01037-5

Economic evaluation of new blood pressure target for hypertensive patients in Taiwan according to the 2022 hypertension clinical practice guidelines of the Taiwan society of cardiology: a simulation modeling study

Hypertens Res. 2023 Jan;46(1):187-199. doi: 10.1038/s41440-022-01037-5. Epub 2022 Oct 14.

Authors

Chia-Te Liao^{1

2

3}, Han Siong Toh^{4

5

6}, Chun-Ting Yang⁷, Chien-Yi Hsu^{8

9

10}, Mei-Chuan Lee^{11

12}, Wei-Ting Chang^{13

14

15}, Zhih-Cherng Chen¹³, Hung-Yu Chang^{16

17}, Carol Strong¹¹

Affiliations

¹ Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan. [email protected].
² Division of Cardiology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan. [email protected].
³ Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium. [email protected].
⁴ Department of Intensive Care Medicine, Chi Mei Medical Center, Tainan, Taiwan. [email protected].
⁵ Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan. [email protected].
⁶ Department of Health and Nutrition, Chia Nan University of Pharmacy & Science, Tainan, Taiwan. [email protected].
⁷ Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
⁸ Division of Cardiology and Cardiovascular Research Center, Department of Internal Medicine, Taipei Medical University, Taipei, Taiwan.
⁹ Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
¹⁰ Taipei Heart Institute, Taipei Medical University, Taipei, Taiwan.
¹¹ Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
¹² Department of Pharmacy, Chi-Mei Medical Centre, Tainan, Taiwan.
¹³ Division of Cardiology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan.
¹⁴ Department of Intensive Care Medicine, Chi Mei Medical Center, Tainan, Taiwan.
¹⁵ Department of Health and Nutrition, Chia Nan University of Pharmacy & Science, Tainan, Taiwan.
¹⁶ Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan.
¹⁷ Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.

PMID: 36229527
DOI: 10.1038/s41440-022-01037-5

Abstract

With the promising cardiovascular benefits in the STEP and SPRINT trials, the 2022 Taiwan's hypertension guidelines redefined the hypertension threshold as 130/80 mmHg and a universal blood-pressure target of <130/80 mmHg. This study's objective was to examine the cost-effectiveness of the intensive blood-pressure target for hypertensive patients using estimated lifetime medical costs and quality-adjusted life years (QALY) from the Taiwan national payer's perspective. We developed a lifetime Markov model comparing the intensive and conservative blood-pressure targets. Incremental cost-effectiveness ratio (ICER) against the willing-to-pay thresholds at the one-time [US$34,000(NT$1,020,000)] and three-time [US$100,000(NT$3,000,000)] gross domestic product per capita were defined as very cost-effect and only cost-effective. The cost-effectiveness in different age stratifications and cardiovascular risks treated with a more intensive target (120 mmHg) were examined in the subgroup analyses. The new blood-pressure treatment target produced more lifetime medical costs [US$31,589(NT$947,670) versus US$26,788(NT$803,640)] and QALYs (12.54 versus 12.25), and the ICER was US$16,589(NT$497,670), which was 99.1% and 100% probability of a very cost-effective and cost-effective strategy. The ICERs in all age stratifications had more than a 90% probability of being very cost-effective, and ICERs decreased with age. More intensive control in patients with high cardiovascular risks produced a lower ICER [US$14,547(NT$436,410)]. In conclusion, Taiwan's new blood-pressure treatment target can prevent more cardiovascular events with acceptable costs per QALY below the willing-to-pay thresholds. The cost-effectiveness of intensive control is consistent across different ages and more pronounced with the increase in age and cardiovascular risk.

Keywords: Cost-effectiveness; Guidelines; Hypertension; Intensive blood-pressure control; Taiwan Society of Cardiology.

MeSH terms

Blood Pressure
Cardiology*
Cost-Benefit Analysis
Humans
Hypertension* / drug therapy
Taiwan