Details:

Alternative Title:
Circulation
Personal Author:
Basu, Sanjay ; Yudkin, John S ; Sussman, Jeremy ; Millett, Christopher ; Hayward, Rod
Basu, Sanjay ; Yudkin, John S ; Sussman, Jeremy ; Millett, Christopher ; Hayward, Rod Less -
Description:
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.


Keywords:
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Adult Aged Blood Pressure Cardiovascular Diseases China Computer Simulation Cost-Benefit Analysis Epidemiology Female Goals Humans Hypertension India Male Middle Aged Myocardial Infarction Prevention Risk Factors Stroke
Source:
Circulation. 133(9):840-848
Pubmed ID:
26762520
Pubmed Central ID:
PMC4775329
Document Type:
Journal Article
Funding:
K08 HL121056/HL/NHLBI NIH HHSUnited States/ ; DP2 MD010478/MD/NIMHD NIH HHSUnited States/ ; P30 DK092926/DK/NIDDK NIH HHSUnited States/ ; R01 HD030880/HD/NICHD NIH HHSUnited States/ ; K08 HL-121056/HL/NHLBI NIH HHSUnited States/ ; ... More +
K08 HL121056/HL/NHLBI NIH HHSUnited States/ ; DP2 MD010478/MD/NIMHD NIH HHSUnited States/ ; P30 DK092926/DK/NIDDK NIH HHSUnited States/ ; R01 HD030880/HD/NICHD NIH HHSUnited States/ ; K08 HL-121056/HL/NHLBI NIH HHSUnited States/ ; R01 HD-30880/HD/NICHD NIH HHSUnited States/ ; R01 DK-056350/DK/NIDDK NIH HHSUnited States/ ; R01 AG-034479/AG/NIA NIH HHSUnited States/ ; RP_2014-04-032/DH_/Department of HealthUnited Kingdom/ ; P30 DK056350/DK/NIDDK NIH HHSUnited States/ ; R24 HD050924/HD/NICHD NIH HHSUnited States/ ; R01 HD-38700/HD/NICHD NIH HHSUnited States/ ; R01 HD038700/HD/NICHD NIH HHSUnited States/ ; P60 DK-20572/DK/NIDDK NIH HHSUnited States/ ; P60 DK020572/DK/NIDDK NIH HHSUnited States/ ; DP2 MD-010478/DP/NCCDPHP CDC HHSUnited States/ ; R24 HD-050924/HD/NICHD NIH HHSUnited States/ ; Wellcome TrustUnited Kingdom/ ; P30 AG017253/AG/NIA NIH HHSUnited States/ ; R01 AG034479/AG/NIA NIH HHSUnited States/ Less -
Collection(s):
CDC Public Access
Main Document Checksum:
[+]
urn:sha256:4cf2342372d43419871c2776f71aec5f8f0f3266db7b572a6442ea8c1dff7c84
Download URL:
https://stacks.cdc.gov/view/cdc/40156/cdc_40156_DS1.pdf
File Type:

Supporting Files

• 	NIHMS748787-supplement-supplemental_material.pdf	pdf
  	nihms748787.nxml	xml
  	nihms748787f1.gif	gif
  	nihms748787f1.jpg	jpeg

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