Screening and Treatment for Subclinical Hypertensive Heart Disease in Emergency Department Patients With Uncontrolled Blood Pressure: A Cost‐effectiveness Analysis. (30th January 2017)

• Record Type: Journal Article
• Authors: Twiner, Michael J.; Marinica, Alexander L.; Kuper, Kenneth; Goodman, Allen; Mahn, James J.; Burla, Michael J.; Brody, Aaron M.; Carroll, Justin A.; Josiah Willock, Robina; Flack, John M.; Nasser, Samar A.; Levy, Phillip D.
• Editors: Diercks, Deborah B.
• Is Part Of: Academic emergency medicine. Volume 24:Number 2(2017)
• Page Start: 168
• Page End: 176
• Publication Date: 2017-01-30
• Subjects: Emergency medicine -- Periodicals; 616.02505
• DOI: 10.1111/acem.13122
• Languages: English
• ISSNs: 1069-6563

Abstract

Abstract: Objectives: Poorly controlled hypertension (HTN) is extremely prevalent and, if left unchecked, subclinical hypertensive heart disease (SHHD) may ensue leading to conditions such as heart failure. To address this, we designed a multidisciplinary program to detect and treat SHHD in a high‐risk, predominantly African American community. The primary objective of this study was to determine the cost‐effectiveness of our program. Methods: Study costs associated with identifying and treating patients with SHHD were calculated and a sensitivity analysis was performed comparing the effect of four parameters on cost estimates. These included prevalence of disease, effectiveness of treatment (regression of SHHD, reversal of left ventricular hypertrophy [LVH], or blood pressure [BP] control as separate measures), echocardiogram costs, and participant time/travel costs. The parent study for this analysis was a single‐center, randomized controlled trial comparing cardiac effects of standard and intense (<120/80 mm Hg) BP goals at 1 year in patients with uncontrolled HTN and SHHD. A total of 149 patients (94% African American) were enrolled, 133 (89%) had SHHD, 123 (93%) of whom were randomized, with 88 (72%) completing the study. Patients were clinically evaluated and medically managed over the course of 1 year with repeated echocardiograms. Costs of these interventions were analyzed and, following standard practices, a cost per quality‐adjusted life‐year (QALY) less than $50, 000 was defined as cost‐effective. Results: Total costs estimates for the program ranged from $117, 044 to $119, 319. Cost per QALY was dependent on SHHD prevalence and the measure of effectiveness but not input costs. Cost‐effectiveness (cost per QALY less than $50, 000) was achieved when SHHD prevalence exceeded 11.1% for regression of SHHD, 4.7% for reversal of LVH, and 2.9% for achievement of BP control. Conclusions: In this cohort of predominantly African American patients with uncontrolled HTN, SHHD prevalence was high and screening with treatment was cost‐effective across a range of assumptions. These data suggest that multidisciplinary programs such as this can be a cost‐effective mechanism to mitigate the cardiovascular consequences of HTN in emergency department patients with uncontrolled BP.