Projected benefits of high BP treatment in China

An expanded program of treatment for hypertension could prevent about 800,000 cardiovascular disease (CVD) events every year in China, according to a modeling study published this week in PLOS Medicine. The predictions of this simulation, reported by Andrew Moran of Columbia University and colleagues, indicate that such a program should also be borderline cost-effective, provided low cost essential anti-hypertensive drugs are used.

Hypertension is the leading cardiovascular risk factor in China, the world's most populous country. About 325 million adults in China have hypertension but less than half are aware of their condition, only 34% of Chinese adults with hypertension are treated with anti-hypertensive drugs, and only 28% of treated individuals achieve the target blood pressure of <140/90 mmHg.

Moran and colleagues used the Cardiovascular Disease Policy Model-China to simulate the costs of hypertension screening, provision of anti-hypertensive medications from China's national essential medicines list, monitoring, and the quality-adjusted life years (QALYs) gained by preventing CVD in Chinese adults with untreated hypertension through 2025. According to the model, treating the subgroup of patients with existing CVD was projected to be cost-saving. Treating hypertension in individuals with and without CVD would prevent between 600,000 and 1,000,000 (95% confidence intervals) CVD events annually, and be borderline cost-effective, at $10,000 to $18,000 (95% CIs; international dollars) per QALY gained.

Numerous assumptions, and data from a range of sources, were incorporated into the model and may limit the accuracy of these findings. Importantly, Moran and colleagues estimate that the cost-effectiveness of the intervention would be greatly reduced if adherence to treatment were lowered or drug costs were increased. The authors state, "Very few past studies have estimated the cost-effectiveness of hypertension treatment in China, and to our knowledge, ours is the first to assess cost-effectiveness by balancing program and intervention costs with projected downstream benefits of prevented CVD events."