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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Cost-effectiveness analysis of hypertension guidelines in South Africa: Absolute risk versus blood pressure level
Circulation, Volume 112, No. 23, Year 2005
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Description
Background - Hypertension is responsible for more deaths worldwide than any other cardiovascular risk factor. Guidelines based on blood pressure level for initiation of treatment of hypertension may be too costly compared with an approach based on absolute cardiovascular disease (CVD) risk, especially in developing countries. Methods and Results - Using a Markov CVD model, we compared 6 strategies for initiation of drug treatment - 2 different blood pressure levels (160/95 and 140/90 mm Hg) and 4 different levels of absolute CVD risk over 10 years (40%, 30%, 20%, and 15%) - with one of no treatment. We modeled a hypothetical cohort of all adults without CVD in South Africa, a multiethnic developing country, over 10 years. The incremental cost-effectiveness ratios for treating those with 10-year absolute risk for CVD >40%, 30%, 20%, and 15% were $700, $1600, $4900, and $11 000 per quality-adjusted life-year gained, respectively. Strategies based on a target blood pressure level were both more expensive and less effective than treatment decisions based on the strategy that used absolute CVD risk of >15%. Sensitivity analysis of cost of treatments, prevalence estimates of risk factors, and benefits expected from treatment did not change the ranking of the strategies. Conclusions - In South Africa, current guidelines based on blood pressure levels are both more expensive and less effective than guidelines based on absolute risk of cardiovascular disease. The use of quantitative risk-based guidelines for treatment of hypertension could free up major resources for other pressing needs, especially in developing countries. © 2005 American Heart Association, Inc.
Authors & Co-Authors
Gaziano, Thomas Andrew
United States, Boston
Brigham and Women's Hospital
Steyn, Krisela
South Africa, Tygerberg
South African Medical Research Council
Cohen, David Joel
United States, Boston
Beth Israel Deaconess Medical Center
Weinstein, Milton C.
United States, Boston
Brigham and Women's Hospital
United States, Boston
Harvard T.h. Chan School of Public Health
Opie, LionelH H.
South Africa, Cape Town
University of Cape Town
Statistics
Citations: 150
Authors: 5
Affiliations: 5
Identifiers
Doi:
10.1161/CIRCULATIONAHA.105.535922
ISSN:
00097322
Research Areas
Noncommunicable Diseases
Study Design
Cross Sectional Study
Cohort Study
Study Approach
Quantitative
Study Locations
South Africa