Journal article
Cost-effectiveness of masked hypertension screening and treatment in US adults with suspected masked hypertension: a simulation study
- Abstract:
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Background
Recent US blood pressure (BP) guidelines recommend using ambulatory BP monitoring (ABPM) or home BP monitoring (HBPM) to screen adults for masked hypertension. However, limited evidence exists of the expected long-term effects of screening for and treating masked hypertension.
Methods
We estimated the lifetime health and economic outcomes of screening for and treating masked hypertension using the Cardiovascular Disease (CVD) Policy Model, a validated microsimulation model. We simulated a cohort of 100,000 US adults aged ≥20 years with suspected masked hypertension (i.e., office BP 120–129/<80 mm Hg, not taking antihypertensive medications, without CVD history). We compared usual care only (i.e., no screening), usual care plus ABPM, and usual care plus HBPM. We projected total direct healthcare costs (2021 USD), quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios. Future costs and QALYs were discounted 3% annually. Secondary outcomes included CVD events and serious adverse events.Results
Relative to usual care, adding masked hypertension screening and treatment with ABPM and HBPM was projected to prevent 14.3 and 20.5 CVD events per 100,000 person-years, increase the proportion experiencing any treatment-related serious adverse events by 2.7 and 5.1 percentage points, and increase mean total costs by USD1,076 and USD1,046, respectively. Compared with usual care, adding ABPM was estimated to cost USD85,164/QALY gained. HBPM resulted in lower QALYs than usual care due to increased treatment-related adverse events and pill-taking disutility.Conclusions
The results from our simulation study suggest screening with ABPM and treating masked hypertension is cost-effective in US adults with suspected masked hypertension.
- Publication status:
- Published
- Peer review status:
- Peer reviewed
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(Preview, Version of record, pdf, 7.7MB, Terms of use)
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- Publisher copy:
- 10.1093/ajh/hpac071
Authors
- Publisher:
- Oxford University Press
- Journal:
- American Journal of Hypertension More from this journal
- Volume:
- 35
- Issue:
- 8
- Pages:
- 752-762
- Publication date:
- 2022-06-05
- Acceptance date:
- 2022-06-01
- DOI:
- EISSN:
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1941-7225
- ISSN:
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0895-7061
- Pmid:
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35665802
- Language:
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English
- Keywords:
- Pubs id:
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1262574
- Local pid:
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pubs:1262574
- Deposit date:
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2022-10-25
Terms of use
- Copyright holder:
- Green et al.
- Copyright date:
- 2022
- Rights statement:
- © The Author(s) 2022. Published by Oxford University Press on behalf of American Journal of Hypertension, Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
- Notes:
- This research was funded in part, by the Wellcome Trust (211182/Z/18/Z). For the purpose of open access, the author has applied a CC BY public copyright license to any Author Accepted Manuscript version arising from this submission.
- Licence:
- CC Attribution (CC BY)
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