Cost-effectiveness analysis of different systolic blood pressure targets for people with a history of stroke or transient ischaemic attack: Economic analysis of the PAST-BP study.

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Penaloza-Ramos, Maria Cristina 
Jowett, Sue 
Barton, Pelham 
Roalfe, Andrea 
Fletcher, Kate 

BACKGROUND: The PAST-BP trial found that using a lower systolic blood pressure target (<130 mmHg or lower versus <140 mmHg) in a primary care population with prevalent cerebrovascular disease was associated with a small additional reduction in blood pressure (2.9 mmHg). OBJECTIVES: To determine the cost effectiveness of an intensive systolic blood pressure target (<130 mmHg or lower) compared with a standard target (<140 mmHg) in people with a history of stroke or transient ischaemic attack on general practice stroke/transient ischaemic attack registers in England. METHODS: A Markov model with a one-year time cycle and a 30-year time horizon was used to estimate the cost per quality-adjusted life year of an intensive target versus a standard target. Individual patient level data were used from the PAST-BP trial with regard to change in blood pressure and numbers of primary care consultations over a 12-month period. Published sources were used to estimate life expectancy and risks of cardiovascular events and their associated costs and utilities. RESULTS: In the base-case results, aiming for an intensive blood pressure target was dominant, with the incremental lifetime costs being £169 lower per patient than for the standard blood pressure target with a 0.08 quality-adjusted life year gain. This was robust to sensitivity analyses, unless intensive blood pressure lowering reduced quality of life by 2% or more. CONCLUSION: Aiming for a systolic blood pressure target of <130 mmHg or lower is cost effective in people who have had a stroke/transient ischaemic attack in the community, but it is difficult to separate out the impact of the lower target from the impact of more active management of blood pressure.

Hypertension, blood pressure target, cost effectiveness, decision analysis, decision model, stroke, transient ischaemic attack, Aged, Aged, 80 and over, Antihypertensive Agents, Blood Pressure, Costs and Cost Analysis, Decision Support Techniques, England, Female, Humans, Hypertension, Incidence, Ischemic Attack, Transient, Male, Middle Aged, Models, Economic, Primary Health Care, Prognosis, Quality-Adjusted Life Years, Stroke, Survival Rate
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Eur J Prev Cardiol
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Oxford University Press (OUP)
National Institute for Health Research (RP-PG-0606-1153)
National Institute for Health Research (Grant ID: RP-PG-0606-1153)