Cost-Effectiveness of Antihypertensive Therapy in Patients Older Than 80 Years: Cohort Study and Markov Model

• Published in: Value in health 2019-12, Vol.22 (12), p.1362-1369
• Main Authors: Hazra, Nisha C., Rudisill, Caroline, Jackson, Stephen H., Gulliford, Martin C.
• Format: Article
• Language: English
• Subjects: Antihypertensives; Blood pressure; Cardiovascular disease; Cardiovascular diseases; Clinical effectiveness; Clinical outcomes; Cohort analysis; Computerized medical records; Coronary artery disease; Cost analysis; Diabetes; Diabetes mellitus; Electronic medical records; Falls; Geriatrics; Health care; Health records; Health services utilization; Heart diseases; Hypertension; Markov chains; Older people; Quality adjusted life years; Risk factors; Risk reduction; Secondary prevention; Sensitivity analysis; Side effects; Stroke; Uncertainty
• ISSN: 1098-3015; 1524-4733
• DOI: 10.1016/j.jval.2019.08.001

Blood pressure and antihypertensive treatment (AHT) generally increase with age, but there is uncertainty concerning the value of treatment at very advanced ages. To estimate the cost-effectiveness of AHT in people aged 80 years and older. A Markov model compared AHT with no blood pressure treatment for prevention of cardiovascular disease. Outcomes were new stroke, coronary heart disease, and diabetes, with falls included as a potential complication of AHT. Costs were evaluated from a health system perspective. Incidence, mortality, and costs of healthcare utilization were estimated from linked primary and secondary care electronic health records for 98 220 individuals aged 80 years and older. Clinical effectiveness estimates were from the Hypertension in the Very Elderly Trial. Deterministic and probabilistic sensitivity analyses were conducted. In the base case, AHT was associated with an additional 725 quality-adjusted life-years (QALYs) and £4.3 million per 1000, with an incremental cost-effectiveness ratio (ICER) of £5977 per QALY. The ICER was most sensitive to the cost of falls and relative risk reduction in stroke incidence. Probabilistic sensitivity analysis gave 95% uncertainty intervals: £5057 to £8398 per QALY in men and £4955 to £8218 per QALY in women. AHT for secondary prevention in participants with coronary heart disease gave an ICER of £9903 per QALY. AHT is estimated to be cost-effective in individuals aged 80 years and older, even if health benefits are smaller or side effects costlier than in the base case. Benefits and harms for vulnerable subgroups require further evaluation. What is already known about the topic?•Blood pressure levels and treatment with antihypertensive therapy (AHT) increase with age, but there is uncertainty concerning the value of treatment at very advanced ages beyond 80 years (over-80s).What does the article add to existing knowledge?•AHT in over-80s was associated with 725 incremental quality-adjusted life-years (QALYs) and incremental healthcare costs of £4.3 million per 1000, resulting in an incremental cost-effectiveness ratio (ICER) of £5977 per QALY. The ICER estimate was sensitive to the costs of treatment-associated falls, but AHT was considered cost-effective in over-80s, even if side effects were more costly than in the base case.What insights does the article provide for informing healthcare-related decision making?•Treatment for hypertension in patients older than 80 years is cost-effective after a