MedicalResearch.com Interview with:
Ilana B. Richman, MD
Palo Alto VA Health Care System, Palo Alto, California
Center for Primary Care and Outcomes Research/Center for Health Policy
Department of Medicine
Stanford University School of Medicine
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: In November of 2015, researchers published results from the Systolic Blood Pressure Intervention Trial (SPRINT). This large, NIH-funded study compared a systolic blood pressure target of 120 mm Hg vs 140 mm Hg among hypertensive, nondiabetic patients at elevated risk for cardiovascular disease. SPRINT reported a 25% reduction in the rate of cardiovascular disease and death among those treated to a lower target. Those treated to a lower target blood pressure, though, experienced certain adverse events more frequently.
Our cost effectiveness analysis asked two questions: given the potential risks and benefits described in SPRINT, does achieving a lower systolic blood pressure result in net benefit over the course of a lifetime? And if it does, how much would it cost, compared to standard treatment? We found that achieving a lower blood pressure target does result in a net benefit, with a gain of about 0.9 years of life (quality adjusted) among those treated to a lower target compared to those treated to a standard target. This gain, though, required some investment. We found that treating to a lower blood pressure target cost $23,777 per quality-adjusted life year gained. Compared to other commonly used interventions here in the US, this would be considered an excellent value.
MedicalResearch.com: What should readers take away from your report?
Response: Our analysis suggests that the approach evaluated in SPRINT results in net benefit over a lifetime and is cost-effective at a typical cost-effectiveness threshold. These findings may be of particular interest to policymakers or clinicians who must consider not only the efficacy of treatments implemented in a population, but also the value of those treatments.
Readers should also be aware that there are some limitations to our analysis. One important caveat is that we relied heavily on estimates of efficacy from SPRINT and our analysis assumes that the core findings from SPRINT are correct. We believe, though, that SPRINT was a well-conducted trial with excellent internal validity and a reasonable basis for this analysis.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: One key question our analysis raises is whether intensive blood pressure management would still be cost-effective among patients at a lower risk of cardiovascular disease. We found that the approach outlined in SPRINT would still be cost effective among patients at lower cardiovascular risk if the benefits described in SPRINT still applied to that population. If, however, lower risk patients also accrued less benefit, the approach described in SPRINT would no longer be cost-effective.
At present, we don’t know whether lower risk patients would benefit similarly to high-risk patients from the approach tested in SPRINT. The HOPE-3 trial, published shortly after SPRINT, evaluated blood pressure treatment among intermediate-risk patients. HOPE-3 did not demonstrate a benefit to hypertension treatment in this population. Unlike SPRINT, though, HOPE-3 evaluated a specific drug regimen rather than a treatment strategy or target, and it remains an open question whether and how much lower risk patients might benefit from intensive blood pressure management as described in SPRINT.
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Richman IB, Fairley M, Jørgensen M, Schuler A, Owens DK, Goldhaber-Fiebert JD. Cost-effectiveness of Intensive Blood Pressure Management. JAMA Cardiol. Published online September 14, 2016. doi:10.1001/jamacardio.2016.3517.
Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.
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