An economic evaluation of blood-pressure control strategies is needed to determine how resources can be allocated to give the greatest benefit. This study attempts to compare intensive versus standard blood-pressure control in terms of both their costs and consequences in Korea.Design and Method:
We developed a decision model for the blood-pressure control of patients 40 years or older at high risk for cardiovascular events. The literature was reviewed to identify possible outcomes and their likelihood following intensive and standard blood-pressure control. The target systolic blood-pressure of the intensive-treatment group was less than 120 mmHg, and that of the standard-treatment was less than 140 mmHg. The primary composite outcome was myocardial infarction, stroke, heart failure, or death from any cause. Health state utility factors were drawn from the literature and were expressed in units of quality-adjusted life years (QALYs). Data for the costs of medications and the average health care costs of the cardiovascular events were obtained from the literature and the 2014 National Inpatient Sample.Results:
In the standard-treatment group, the cost of treating hypertensive patients was 27,328,483 KRWs (approx. 24,000 USD) and the quality-adjusted life years (QALYs) were 31.10. On the other hand, in the intensive-treatment group, the cost of treating hypertensive patients was 28,183,175 KRWs (approx. 24800 USD) and the quality-adjusted life years (QALYs) were 31.44. Therefore, the incremental cost-effectiveness ratio (ICER) was 2,513,799 KRWs (approx. 2,212 USD), which is an acceptable societal strategy in Korea.Conclusions:
The current literature suggests that intensive blood-pressure control in which the target systolic blood-pressure is less than 120 mmHg is clinically more effective than the standard-treatment with less than 140 mmHg. Our results show that such an intensive control for the patients at high risk for cardiovascular events is also economically viable.