26762520

PMC4775329

Background

The World Health Organization (WHO) aims to reduce mortality from chronic diseases including cardiovascular disease (CVD) by 25% by 2025. High blood pressure (BP) is a leading CVD risk factor. We sought to compare three strategies for treating BP in China and India: a treat-to-target (TTT) strategy emphasizing lowering BP to a target, a benefit-based tailored treatment (BTT) strategy emphasizing lowering CVD risk, or a hybrid strategy currently recommended by the WHO.

Methods and Results

We developed a microsimulation model of adults aged 30–70 years old in China and in India to compare the two treatment approaches across a 10-year policy-planning horizon. In the model, a BTT strategy treating adults with a 10-year CVD event risk ≥10% used similar financial resources but averted about 5 million more DALYs in both China and India than a TTT approach based on current U.S. guidelines. The hybrid strategy in current WHO guidelines produced no substantial benefits over TTT. BTT was more cost-effective at $205–$272/ DALY averted, which was $142–$182 less per DALY than TTT or hybrid strategies. The comparative effectiveness of BTT was robust to uncertainties in CVD risk estimation or to variations in the age range analyzed, the BTT treatment threshold, or rates of treatment access, adherence, or concurrent statin therapy.

Conclusions

In model-based analyses, a simple BTT strategy was more effective and cost-effective than TTT or hybrid strategies in reducing mortality.

CDC Public Access

K08 HL121056/HL/NHLBI NIH HHS/United States
DP2 MD010478/MD/NIMHD NIH HHS/United States
R01 HD038700/HD/NICHD NIH HHS/United States
P60 DK-20572/DK/NIDDK NIH HHS/United States
R01 HD030880/HD/NICHD NIH HHS/United States
K08 HL-121056/HL/NHLBI NIH HHS/United States
R01 HD-30880/HD/NICHD NIH HHS/United States
R01 DK-056350/DK/NIDDK NIH HHS/United States
P60 DK020572/DK/NIDDK NIH HHS/United States
DP2 MD-010478/DP/NCCDPHP CDC HHS/United States
R01 AG-034479/AG/NIA NIH HHS/United States
P30 DK056350/DK/NIDDK NIH HHS/United States
R24 HD-050924/HD/NICHD NIH HHS/United States
R24 HD050924/HD/NICHD NIH HHS/United States
Wellcome Trust/United Kingdom
R01 HD-38700/HD/NICHD NIH HHS/United States
P30 AG017253/AG/NIA NIH HHS/United States
R01 AG034479/AG/NIA NIH HHS/United States