Applicability and cost-effectiveness of the Systolic Blood Pressure Intervention Trial (SPRINT) in the Chinese population: A cost-effectiveness modeling study
The Systolic Blood Pressure Intervention Trial (SPRINT) showed significant reductions in death and cardiovascular disease (CVD) risk with a systolic blood pressure (SBP) goal of
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| creator | Li, Chao Chen, Kangyu Cornelius, Victoria Tomeny, Ewan Wang, Yang Yang, Xiaowei Yuan, Xiaodan Qin, Rui Yu, Dahai Wu, Zhenqiang Wang, Duolao Chen, Tao |
| description | The Systolic Blood Pressure Intervention Trial (SPRINT) showed significant reductions in death and cardiovascular disease (CVD) risk with a systolic blood pressure (SBP) goal of |
| doi_str_mv | 10.1371/journal.pmed.1003515 |
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We used nationally representative baseline data from the China Health and Retirement Longitudinal Study (CHARLS) (2011-2012) to estimate the prevalence and number of Chinese adults aged 45 years and older who meet SPRINT criteria. A validated microsimulation model was employed to project costs, clinical outcomes, and quality-adjusted life-years (QALYs) among SPRINT-eligible adults, under 2 alternative treatment strategies (SBP goal of <120 mm Hg [intensive treatment] and SBP goal of <140 mm Hg [standard treatment]). Overall, 22.2% met the SPRINT criteria, representing 116.2 (95% CI 107.5 to 124.8) million people in China. Of these, 66.4%, representing 77.2 (95% CI 69.3 to 85.0) million, were not being treated for hypertension, and 22.9%, representing 26.6 (95% CI 22.4 to 30.7) million, had a SBP between 130 and 139 mm Hg, yet were not taking antihypertensive medication. We estimated that over 5 years, compared to standard treatment, intensive treatment would reduce heart failure incidence by 0.84 (95% CI 0.42 to 1.25) million cases, reduce CVD deaths by 2.03 (95% CI 1.44 to 2.63) million cases, and save 3.84 (95% CI 1.53 to 6.34) million life-years. Estimated reductions of 0.069 (95% CI -0.28, 0.42) million myocardial infarction cases and 0.36 (95% CI -0.10, 0.82) million stroke cases were not statistically significant. Furthermore, over a lifetime, moving from standard to intensive treatment increased the mean QALYs from 9.51 to 9.87 (an increment of 0.38 [95% CI 0.13 to 0.71]), at a cost of Int$10,997 per QALY gained. Of all 1-way sensitivity analyses, high antihypertensive drug cost and lower treatment efficacy for CVD death resulted in the 2 most unfavorable results (Int$25,291 and Int$18,995 per QALY were gained, respectively). Simulation results indicated that intensive treatment could be cost-effective (82.8% probability of being below the willingness-to-pay threshold of Int$16,782 [1× GDP per capita in China in 2017]), with a lower probability in people with SBP 130-139 mm Hg (72.9%) but a higher probability among females (91.2%). Main limitations include lack of specific SPRINT eligibility information in the CHARLS survey, uncertainty about the implications of different blood pressure measurement techniques, the use of several sources of data with large reliance on findings from SPPRINT, limited information about the serious adverse event rate, and lack of information and evidence for medication effectiveness on renal disease.
Although adoption of the SPRINT treatment strategy would increase the number of Chinese adults requiring SBP treatment intensification, this approach has the potential to prevent CVD events, to produce gains in life-years, and to be cost-effective under common thresholds.</description><identifier>ISSN: 1549-1676</identifier><identifier>ISSN: 1549-1277</identifier><identifier>EISSN: 1549-1676</identifier><identifier>DOI: 10.1371/journal.pmed.1003515</identifier><identifier>PMID: 33661907</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Adverse events ; Age ; Antihypertensives ; Blood pressure ; Cardiovascular disease ; Cardiovascular diseases ; Care and treatment ; Complications and side effects ; Coronary artery disease ; Cost analysis ; Heart diseases ; Hypertension ; Medicine and Health Sciences ; Mortality ; Population ; Population studies ; Prescription drugs ; Prevention ; Purchasing power parity ; Regulation ; Risk factors ; Social Sciences ; Stroke</subject><ispartof>PLoS medicine, 2021-03, Vol.18 (3), p.e1003515-e1003515</ispartof><rights>COPYRIGHT 2021 Public Library of Science</rights><rights>2021 Li et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2021 Li et al 2021 Li et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c631t-4b29c6f4c84b36fbe0746c08bbbd224bc5c94c7981428be21d342077759853dc3</citedby><cites>FETCH-LOGICAL-c631t-4b29c6f4c84b36fbe0746c08bbbd224bc5c94c7981428be21d342077759853dc3</cites><orcidid>0000-0002-7095-6767 ; 0000-0002-5489-6450 ; 0000-0003-2788-2464 ; 0000-0002-0080-1065 ; 0000-0002-5040-2492 ; 0000-0003-4547-2389 ; 0000-0002-8449-7725 ; 0000-0002-6712-8602</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7971845/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7971845/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,2096,2915,23845,27901,27902,53766,53768,79343,79344</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33661907$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Li, Chao</creatorcontrib><creatorcontrib>Chen, Kangyu</creatorcontrib><creatorcontrib>Cornelius, Victoria</creatorcontrib><creatorcontrib>Tomeny, Ewan</creatorcontrib><creatorcontrib>Wang, Yang</creatorcontrib><creatorcontrib>Yang, Xiaowei</creatorcontrib><creatorcontrib>Yuan, Xiaodan</creatorcontrib><creatorcontrib>Qin, Rui</creatorcontrib><creatorcontrib>Yu, Dahai</creatorcontrib><creatorcontrib>Wu, Zhenqiang</creatorcontrib><creatorcontrib>Wang, Duolao</creatorcontrib><creatorcontrib>Chen, Tao</creatorcontrib><title>Applicability and cost-effectiveness of the Systolic Blood Pressure Intervention Trial (SPRINT) in the Chinese population: A cost-effectiveness modeling study</title><title>PLoS medicine</title><addtitle>PLoS Med</addtitle><description>The Systolic Blood Pressure Intervention Trial (SPRINT) showed significant reductions in death and cardiovascular disease (CVD) risk with a systolic blood pressure (SBP) goal of <120 mm Hg compared with a SBP goal of <140 mm Hg. Our study aimed to assess the applicability of SPRINT to Chinese adults. Additionally, we sought to predict the medical and economic implications of this intensive SBP treatment among those meeting SPRINT eligibility.
We used nationally representative baseline data from the China Health and Retirement Longitudinal Study (CHARLS) (2011-2012) to estimate the prevalence and number of Chinese adults aged 45 years and older who meet SPRINT criteria. A validated microsimulation model was employed to project costs, clinical outcomes, and quality-adjusted life-years (QALYs) among SPRINT-eligible adults, under 2 alternative treatment strategies (SBP goal of <120 mm Hg [intensive treatment] and SBP goal of <140 mm Hg [standard treatment]). Overall, 22.2% met the SPRINT criteria, representing 116.2 (95% CI 107.5 to 124.8) million people in China. Of these, 66.4%, representing 77.2 (95% CI 69.3 to 85.0) million, were not being treated for hypertension, and 22.9%, representing 26.6 (95% CI 22.4 to 30.7) million, had a SBP between 130 and 139 mm Hg, yet were not taking antihypertensive medication. We estimated that over 5 years, compared to standard treatment, intensive treatment would reduce heart failure incidence by 0.84 (95% CI 0.42 to 1.25) million cases, reduce CVD deaths by 2.03 (95% CI 1.44 to 2.63) million cases, and save 3.84 (95% CI 1.53 to 6.34) million life-years. Estimated reductions of 0.069 (95% CI -0.28, 0.42) million myocardial infarction cases and 0.36 (95% CI -0.10, 0.82) million stroke cases were not statistically significant. Furthermore, over a lifetime, moving from standard to intensive treatment increased the mean QALYs from 9.51 to 9.87 (an increment of 0.38 [95% CI 0.13 to 0.71]), at a cost of Int$10,997 per QALY gained. Of all 1-way sensitivity analyses, high antihypertensive drug cost and lower treatment efficacy for CVD death resulted in the 2 most unfavorable results (Int$25,291 and Int$18,995 per QALY were gained, respectively). Simulation results indicated that intensive treatment could be cost-effective (82.8% probability of being below the willingness-to-pay threshold of Int$16,782 [1× GDP per capita in China in 2017]), with a lower probability in people with SBP 130-139 mm Hg (72.9%) but a higher probability among females (91.2%). Main limitations include lack of specific SPRINT eligibility information in the CHARLS survey, uncertainty about the implications of different blood pressure measurement techniques, the use of several sources of data with large reliance on findings from SPPRINT, limited information about the serious adverse event rate, and lack of information and evidence for medication effectiveness on renal disease.
Although adoption of the SPRINT treatment strategy would increase the number of Chinese adults requiring SBP treatment intensification, this approach has the potential to prevent CVD events, to produce gains in life-years, and to be cost-effective under common thresholds.</description><subject>Adverse events</subject><subject>Age</subject><subject>Antihypertensives</subject><subject>Blood pressure</subject><subject>Cardiovascular disease</subject><subject>Cardiovascular diseases</subject><subject>Care and treatment</subject><subject>Complications and side effects</subject><subject>Coronary artery disease</subject><subject>Cost analysis</subject><subject>Heart diseases</subject><subject>Hypertension</subject><subject>Medicine and Health Sciences</subject><subject>Mortality</subject><subject>Population</subject><subject>Population studies</subject><subject>Prescription drugs</subject><subject>Prevention</subject><subject>Purchasing power parity</subject><subject>Regulation</subject><subject>Risk factors</subject><subject>Social Sciences</subject><subject>Stroke</subject><issn>1549-1676</issn><issn>1549-1277</issn><issn>1549-1676</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>BENPR</sourceid><sourceid>DOA</sourceid><recordid>eNptkstuEzEUhkcIREvhDRBYYlMWE3wbe8wCKURcIlVQ0bC2PLYnceSMB3umUl6GZ8Vp0qpBkRe27O__z8WnKF4jOEGEow_rMMZO-Um_sWaCICQVqp4U56iiokSMs6ePzmfFi5TWEGIBBXxenBHCGBKQnxd_p33vnVaN827YAtUZoEMaStu2Vg_u1nY2JRBaMKwsuNmmIWQafPYhGHAd89sYLZh3g40ZHVzowCI65cHlzfWv-Y_Fe-C6O-ls5bKTBX3oR6924EcwPRVqE4z1rluCNIxm-7J41iqf7KvDflH8_vplMfteXv38Np9Nr0rNCBpK2mChWUt1TRvC2sZCTpmGddM0BmPa6EoLqrmoEcV1YzEyhGLIOa9EXRGjyUXxdu_b-5DkobVJ4goRVjPEWCbme8IEtZZ9dBsVtzIoJ-8uQlxKFQenvZU1sgxjISomDCWoqg3HDWsNrZHWusbZ69Mh2tjk39O5c1H5I9Pjl86t5DLcSi44qmmVDS4PBjH8GW0a5MYlbb1XnQ1jzpvmuiCHXGT03X_o6eoO1FLlAlzXhhxX70zllFU1R1gQmqnyBLXMH5eTDJ1tXb4-4icn-LyM3Th9UkD3Ah1DStG2Dz1BUO6m_j55uZt6eZj6LHvzuJ8PovsxJ_8AZtEANA</recordid><startdate>20210304</startdate><enddate>20210304</enddate><creator>Li, Chao</creator><creator>Chen, Kangyu</creator><creator>Cornelius, Victoria</creator><creator>Tomeny, Ewan</creator><creator>Wang, Yang</creator><creator>Yang, Xiaowei</creator><creator>Yuan, Xiaodan</creator><creator>Qin, Rui</creator><creator>Yu, Dahai</creator><creator>Wu, Zhenqiang</creator><creator>Wang, Duolao</creator><creator>Chen, Tao</creator><general>Public Library of Science</general><general>Public Library of Science (PLoS)</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7TK</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope><scope>CZK</scope><orcidid>https://orcid.org/0000-0002-7095-6767</orcidid><orcidid>https://orcid.org/0000-0002-5489-6450</orcidid><orcidid>https://orcid.org/0000-0003-2788-2464</orcidid><orcidid>https://orcid.org/0000-0002-0080-1065</orcidid><orcidid>https://orcid.org/0000-0002-5040-2492</orcidid><orcidid>https://orcid.org/0000-0003-4547-2389</orcidid><orcidid>https://orcid.org/0000-0002-8449-7725</orcidid><orcidid>https://orcid.org/0000-0002-6712-8602</orcidid></search><sort><creationdate>20210304</creationdate><title>Applicability and cost-effectiveness of the Systolic Blood Pressure Intervention Trial (SPRINT) in the Chinese population: A cost-effectiveness modeling study</title><author>Li, Chao ; Chen, Kangyu ; Cornelius, Victoria ; Tomeny, Ewan ; Wang, Yang ; Yang, Xiaowei ; Yuan, Xiaodan ; Qin, Rui ; Yu, Dahai ; Wu, Zhenqiang ; Wang, Duolao ; Chen, Tao</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c631t-4b29c6f4c84b36fbe0746c08bbbd224bc5c94c7981428be21d342077759853dc3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Adverse events</topic><topic>Age</topic><topic>Antihypertensives</topic><topic>Blood pressure</topic><topic>Cardiovascular disease</topic><topic>Cardiovascular diseases</topic><topic>Care and treatment</topic><topic>Complications and side effects</topic><topic>Coronary artery disease</topic><topic>Cost analysis</topic><topic>Heart diseases</topic><topic>Hypertension</topic><topic>Medicine and Health Sciences</topic><topic>Mortality</topic><topic>Population</topic><topic>Population studies</topic><topic>Prescription drugs</topic><topic>Prevention</topic><topic>Purchasing power parity</topic><topic>Regulation</topic><topic>Risk factors</topic><topic>Social Sciences</topic><topic>Stroke</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Li, Chao</creatorcontrib><creatorcontrib>Chen, Kangyu</creatorcontrib><creatorcontrib>Cornelius, Victoria</creatorcontrib><creatorcontrib>Tomeny, Ewan</creatorcontrib><creatorcontrib>Wang, Yang</creatorcontrib><creatorcontrib>Yang, Xiaowei</creatorcontrib><creatorcontrib>Yuan, Xiaodan</creatorcontrib><creatorcontrib>Qin, Rui</creatorcontrib><creatorcontrib>Yu, Dahai</creatorcontrib><creatorcontrib>Wu, Zhenqiang</creatorcontrib><creatorcontrib>Wang, Duolao</creatorcontrib><creatorcontrib>Chen, Tao</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Neurosciences Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><collection>PLoS Medicine</collection><jtitle>PLoS medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Li, Chao</au><au>Chen, Kangyu</au><au>Cornelius, Victoria</au><au>Tomeny, Ewan</au><au>Wang, Yang</au><au>Yang, Xiaowei</au><au>Yuan, Xiaodan</au><au>Qin, Rui</au><au>Yu, Dahai</au><au>Wu, Zhenqiang</au><au>Wang, Duolao</au><au>Chen, Tao</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Applicability and cost-effectiveness of the Systolic Blood Pressure Intervention Trial (SPRINT) in the Chinese population: A cost-effectiveness modeling study</atitle><jtitle>PLoS medicine</jtitle><addtitle>PLoS Med</addtitle><date>2021-03-04</date><risdate>2021</risdate><volume>18</volume><issue>3</issue><spage>e1003515</spage><epage>e1003515</epage><pages>e1003515-e1003515</pages><issn>1549-1676</issn><issn>1549-1277</issn><eissn>1549-1676</eissn><abstract>The Systolic Blood Pressure Intervention Trial (SPRINT) showed significant reductions in death and cardiovascular disease (CVD) risk with a systolic blood pressure (SBP) goal of <120 mm Hg compared with a SBP goal of <140 mm Hg. Our study aimed to assess the applicability of SPRINT to Chinese adults. Additionally, we sought to predict the medical and economic implications of this intensive SBP treatment among those meeting SPRINT eligibility.
We used nationally representative baseline data from the China Health and Retirement Longitudinal Study (CHARLS) (2011-2012) to estimate the prevalence and number of Chinese adults aged 45 years and older who meet SPRINT criteria. A validated microsimulation model was employed to project costs, clinical outcomes, and quality-adjusted life-years (QALYs) among SPRINT-eligible adults, under 2 alternative treatment strategies (SBP goal of <120 mm Hg [intensive treatment] and SBP goal of <140 mm Hg [standard treatment]). Overall, 22.2% met the SPRINT criteria, representing 116.2 (95% CI 107.5 to 124.8) million people in China. Of these, 66.4%, representing 77.2 (95% CI 69.3 to 85.0) million, were not being treated for hypertension, and 22.9%, representing 26.6 (95% CI 22.4 to 30.7) million, had a SBP between 130 and 139 mm Hg, yet were not taking antihypertensive medication. We estimated that over 5 years, compared to standard treatment, intensive treatment would reduce heart failure incidence by 0.84 (95% CI 0.42 to 1.25) million cases, reduce CVD deaths by 2.03 (95% CI 1.44 to 2.63) million cases, and save 3.84 (95% CI 1.53 to 6.34) million life-years. Estimated reductions of 0.069 (95% CI -0.28, 0.42) million myocardial infarction cases and 0.36 (95% CI -0.10, 0.82) million stroke cases were not statistically significant. Furthermore, over a lifetime, moving from standard to intensive treatment increased the mean QALYs from 9.51 to 9.87 (an increment of 0.38 [95% CI 0.13 to 0.71]), at a cost of Int$10,997 per QALY gained. Of all 1-way sensitivity analyses, high antihypertensive drug cost and lower treatment efficacy for CVD death resulted in the 2 most unfavorable results (Int$25,291 and Int$18,995 per QALY were gained, respectively). Simulation results indicated that intensive treatment could be cost-effective (82.8% probability of being below the willingness-to-pay threshold of Int$16,782 [1× GDP per capita in China in 2017]), with a lower probability in people with SBP 130-139 mm Hg (72.9%) but a higher probability among females (91.2%). Main limitations include lack of specific SPRINT eligibility information in the CHARLS survey, uncertainty about the implications of different blood pressure measurement techniques, the use of several sources of data with large reliance on findings from SPPRINT, limited information about the serious adverse event rate, and lack of information and evidence for medication effectiveness on renal disease.
Although adoption of the SPRINT treatment strategy would increase the number of Chinese adults requiring SBP treatment intensification, this approach has the potential to prevent CVD events, to produce gains in life-years, and to be cost-effective under common thresholds.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>33661907</pmid><doi>10.1371/journal.pmed.1003515</doi><orcidid>https://orcid.org/0000-0002-7095-6767</orcidid><orcidid>https://orcid.org/0000-0002-5489-6450</orcidid><orcidid>https://orcid.org/0000-0003-2788-2464</orcidid><orcidid>https://orcid.org/0000-0002-0080-1065</orcidid><orcidid>https://orcid.org/0000-0002-5040-2492</orcidid><orcidid>https://orcid.org/0000-0003-4547-2389</orcidid><orcidid>https://orcid.org/0000-0002-8449-7725</orcidid><orcidid>https://orcid.org/0000-0002-6712-8602</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Adverse events Age Antihypertensives Blood pressure Cardiovascular disease Cardiovascular diseases Care and treatment Complications and side effects Coronary artery disease Cost analysis Heart diseases Hypertension Medicine and Health Sciences Mortality Population Population studies Prescription drugs Prevention Purchasing power parity Regulation Risk factors Social Sciences Stroke |
| title | Applicability and cost-effectiveness of the Systolic Blood Pressure Intervention Trial (SPRINT) in the Chinese population: A cost-effectiveness modeling study |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-28T14%3A13%3A41IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_plos_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Applicability%20and%20cost-effectiveness%20of%20the%20Systolic%20Blood%20Pressure%20Intervention%20Trial%20(SPRINT)%20in%20the%20Chinese%20population:%20A%20cost-effectiveness%20modeling%20study&rft.jtitle=PLoS%20medicine&rft.au=Li,%20Chao&rft.date=2021-03-04&rft.volume=18&rft.issue=3&rft.spage=e1003515&rft.epage=e1003515&rft.pages=e1003515-e1003515&rft.issn=1549-1676&rft.eissn=1549-1676&rft_id=info:doi/10.1371/journal.pmed.1003515&rft_dat=%3Cgale_plos_%3EA658712934%3C/gale_plos_%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2513686166&rft_id=info:pmid/33661907&rft_galeid=A658712934&rft_doaj_id=oai_doaj_org_article_81e62299569d43158d72b6fd481ccc82&rfr_iscdi=true |