P-180: Avoiding adverse cardiovascular outcomes with prompt blood pressure control: An economic analysis based on the valsartan antihypertensive long-term use evaluation (VALUE) trial

Improved outcomes in hypertensive patients are usually ascribed to the benefit of gradual blood pressure (BP) control over the long-term. There is a paucity of data on the effects of prompt BP lowering on cardiovascular (CV) outcomes over the short-term. Recent results from the VALUE trial demonstrate significant reductions in CV events in patients at high CV risk, associated with BP lowering over the first 3 months. This analysis therefore examines the cost-effectiveness of antihypertensive therapy, based on CV event rate reduction in the first 3 months of the VALUE trial. An economic model was developed to determine costs per event avoided for stroke and all-cause mortality in the 0–3 month period of the VALUE trial (the only discrete outcomes showing significant differences between regimens in the early treatment period). Drug utilization was determined from the VALUE publication (Julius et al. Lancet, 2004; 363:2022); drug costs were taken from public sources reflecting retail pharmacy pricing. Stroke and all-cause mortality event rates were determined from the published paper using Kaplan-Meier graphs and reported odds ratios (OR) with 95% confidence intervals (CI), for valsartan vs amlodipine: stroke 1.94 (1.10–3.42); all-cause mortality 2.84 (1.51–5.34). Sensitivity analyses were conducted based on the upper and lower bounds of the CI for the OR and ±20% on event rates. Over 3 months, amlodipine-based treatment reduced mean systolic BP by 3.8 mm Hg more than valsartan-based treatment, leading to reduction of 36 strokes and 53 fewer deaths per 15,000 patients. Associated drug cost is $9.67 higher per patient with amlodipine vs. valsartan. Cost per stroke averted is $4,003 and cost per all-cause death avoided is $2,742. Sensitivity analyses demonstrated a range of $2,282-$26,698 per stroke averted and $1,821-$6,582 per all-cause death avoided. All antihypertensive regimens may not be equally efficacious at rapidly reducing BP to goal. Among patients at relatively high risk for CV events, prompt BP reduction with amlodipine-based therapy as seen in VALUE, can reduce stroke and all-cause mortality within the first 3 months. These results reinforce the cost-effectiveness of optimal combination antihypertensive therapy for early and aggressive BP lowering to reduce CV events.