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Alternative strategies to achieve cardiovascular mortality goals in China and India: a microsimulation of target- versus risk-based blood pressure treatment

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Title: Alternative strategies to achieve cardiovascular mortality goals in China and India: a microsimulation of target- versus risk-based blood pressure treatment
Author(s): Basu, S
Yudkin, JS
Sussman, JB
Millett, C
Hayward, RA
Item Type: Journal Article
Abstract: Background—The World Health Organization aims to reduce mortality from chronic diseases including cardiovascular disease (CVD) by 25% by 2025. High blood pressure is a leading CVD risk factor. We sought to compare 3 strategies for treating blood pressure in China and India: a treat-to-target (TTT) strategy emphasizing lowering blood pressure to a target, a benefit-based tailored treatment (BTT) strategy emphasizing lowering CVD risk, or a hybrid strategy currently recommended by the World Health Organization. Methods and Results—We developed a microsimulation model of adults aged 30 to 70 years in China and in India to compare the 2 treatment approaches across a 10-year policy-planning horizon. In the model, a BTT strategy treating adults with a 10-year CVD event risk of ≥10% used similar financial resources but averted ≈5 million more disability-adjusted life-years in both China and India than a TTT approach based on current US guidelines. The hybrid strategy in the current World Health Organization guidelines produced no substantial benefits over TTT. BTT was more cost-effective at $205 to $272/disability-adjusted life-year averted, which was $142 to $182 less per disability-adjusted life-year than TTT or hybrid strategies. The comparative effectiveness of BTT was robust to uncertainties in CVD risk estimation and to variations in the age range analyzed, the BTT treatment threshold, or rates of treatment access, adherence, or concurrent statin therapy. Conclusions—In model-based analyses, a simple BTT strategy was more effective and cost-effective than TTT or hybrid strategies in reducing mortality.
Publication Date: 13-Jan-2016
Date of Acceptance: 29-Dec-2015
URI: http://hdl.handle.net/10044/1/45108
DOI: http://dx.doi.org/10.1161/CIRCULATIONAHA.115.019985
ISSN: 0009-7322
Publisher: American Heart Association
Start Page: 840
End Page: 848
Journal / Book Title: Circulation
Volume: 133
Issue: 9
Copyright Statement: © 2016 American Heart Association, Inc.
Keywords: Science & Technology
Life Sciences & Biomedicine
Cardiac & Cardiovascular Systems
Peripheral Vascular Disease
Cardiovascular System & Cardiology
epidemiology
hypertension
myocardial infarction
prevention & control
stroke
MIDDLE-INCOME COUNTRIES
COST-EFFECTIVENESS ANALYSIS
INDIVIDUAL-PATIENT DATA
SECONDARY PREVENTION
RANDOMIZED-TRIALS
LOWERING TREATMENT
GLOBAL BURDEN
DISEASE
METAANALYSIS
HEALTH
epidemiology
hypertension
myocardial infarction
prevention & control
stroke
Adult
Aged
Blood Pressure
Cardiovascular Diseases
China
Computer Simulation
Cost-Benefit Analysis
Female
Goals
Humans
Hypertension
India
Male
Middle Aged
Risk Factors
Humans
Cardiovascular Diseases
Hypertension
Risk Factors
Goals
Blood Pressure
Computer Simulation
Adult
Aged
Middle Aged
Cost-Benefit Analysis
India
China
Female
Male
Cardiovascular System & Hematology
1103 Clinical Sciences
1102 Cardiovascular Medicine And Haematology
1117 Public Health And Health Services
Publication Status: Published
Appears in Collections:Faculty of Medicine
Epidemiology, Public Health and Primary Care



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