Effect of Systolic Blood Pressure Measurement Error on the Cost-Effectiveness of Intensive Blood Pressure Targets.

Abstract

Analyses of clinical trials find that an intensive systolic blood pressure (SBP) target of less than 120 mm Hg is cost-effective compared with a target of less than 140 mm Hg for patients at high cardiovascular disease risk. However, guidelines from the American College of Cardiology and American Heart Association recommend a target of less than 130 mm Hg, citing blood pressure measurement error in routine practice. To evaluate the effect of measurement error on the cost-effectiveness of intensive SBP targets. Microsimulation model varying SBP measurement error. SPRINT (Systolic Blood Pressure Intervention Trial) data and published literature. Patients at high cardiovascular risk. Lifetime. Health care sector. SBP targets of less than 120 mm Hg, less than 130 mm Hg, and less than 140 mm Hg. Incremental cost-effectiveness ratios (ICERs). With research-grade SBP measurement (mean error, 0 mm Hg), the ICER for the target of less than 120 mm Hg versus less than 130 mm Hg was $24 400 per quality-adjusted life-year (QALY). With average measurement error (mean error, 7.3 mm Hg in the <120-mm Hg target), the ICER increased to $42 000 per QALY. The ICER for the target of less than 120 mm Hg was greater than $100 000 per QALY in scenarios with high error (mean error, ≥14.6 mm Hg in the <120-mm Hg target), when an inflection point for increasing risk for cardiovascular disease (CVD) was at or above 116 mm Hg, and in scenarios with a medication-taking disutility of at least 0.003 per antihypertensive medication. Uncertainty in the relationship between low treated SBP (for example, <115 mm Hg) and cardiovascular risk. For SPRINT-eligible patients at high cardiovascular risk without diabetes or prior stroke, a target of less than 120 mm Hg seems cost-effective across most settings with SBP measurement error. In scenarios with high error and an increase in CVD risk at low SBPs, a target of less than 130 mm Hg may become cost-effective. National Science Foundation and National Institute of Neurological Disorders and Stroke.