Cost effectiveness of intensive treatment of hypertension

The Hypertension Optimal Treatment (HOT) study showed that substantial redu ctions in blood pressure and a corresponding lowering of the risk of myocar dial infarction could be achieved by intensive antihypertensive therapy. A cost-effectiveness analysis was performed to determine the possible economi c consequences of three different targets of diastolic blood pressure lower ing-less than or equal to 90 mm Hg, less than or equal to 85 mm Hg, and les s than or equal to 80 mm Hg, and of the coadministration of aspirin. The cost of each drug was first estimated at high and low dosage. Next, by drawing on data from the HOT trial, the mixture and dosage of drugs for eac h level of blood pressure control were estimated. This allowed computation of the annual cost of drugs for each blood pressure target. Because the rate of myocardial infarction (MI) was the only endpoint that d iffered significantly among the three target blood pressure groups, the MI risk data were converted into years of life gained on the basis of fataliti es from MI averted. The cost-effectiveness ratios, expressed as cost, per y ear of life gained, were most: favorable for the 190-mm Hg treatment target group ($4262) and for added aspirin treatment ($12,710). For moderately ag gressive treatment (blood pressure less than or equal to 85 mm Hg), the cos t-effectiveness ratio escalated incrementally to $86,360 and with intensive treatment to $658,370 per year of lift: gained, Thus treatment to a target of 90 mm Hg and coadministering aspirin were considered highly cost effect ive, whereas treatments to lower the blood pressure further 85 mm Hg were m arginally cost effective; intensive blood pressure lowering down to 80 mm H g was not cost effective.