Main assumptions for the effect of salt intervention and CVD treatment costs, the CVD Policy Model-China.

<p>Main assumptions for the effect of salt intervention and CVD treatment costs, the CVD Policy Model-China.</p

Simulated SBP reduction and annual cardiovascular disease outcomes (coronary heart disease and stroke combined) after implementing dietary salt intervention strategies in China, 2010 to 2019, according to the CVD Policy Model-China.

<p>Simulated SBP reduction and annual cardiovascular disease outcomes (coronary heart disease and stroke combined) after implementing dietary salt intervention strategies in China, 2010 to 2019, according to the CVD Policy Model-China.</p

Annual benefits of CVD prevention projected for salt intake interventions by region in China.

<p>Bars represent the main simulation point estimate. I bars indicate 95% uncertainty intervals of the gained benefit among the overall population from 1 000 probabilistic simulations. CVD, cardiovascular disease; Int$, international dollars; QALY, quality-adjusted life years.</p

Conceptual diagram of the effect of salt reduction on the CVD prevention.

<p>AMI, acute myocardial infarction; BMI, body mass index; CHD, coronary heart disease; CVD, cardiovascular disease; HDL-C, high-density lipoprotein cholesterol; LDL-C, low density lipoprotein cholesterol; SBP, systolic blood pressure.</p

Mean SBP levels, salt intake level, and relative risks of CVD associated with SBP changes within CVD Policy Model categories.

<p>Mean SBP levels, salt intake level, and relative risks of CVD associated with SBP changes within CVD Policy Model categories.</p

Simulated SBP reductions and annual cardiovascular disease outcomes (coronary heart disease and stroke combined) after achieving dietary salt reduction goals in China, from 2010 to 2019, according to the CVD Policy Model-China.

<p>Simulated SBP reductions and annual cardiovascular disease outcomes (coronary heart disease and stroke combined) after achieving dietary salt reduction goals in China, from 2010 to 2019, according to the CVD Policy Model-China.</p

The Cost-Effectiveness of Low-Cost Essential Antihypertensive Medicines for Hypertension Control in China: A Modelling Study

<div><p>Background</p><p>Hypertension is China’s leading cardiovascular disease risk factor. Improved hypertension control in China would result in result in enormous health gains in the world’s largest population. A computer simulation model projected the cost-effectiveness of hypertension treatment in Chinese adults, assuming a range of essential medicines list drug costs.</p><p>Methods and Findings</p><p>The Cardiovascular Disease Policy Model-China, a Markov-style computer simulation model, simulated hypertension screening, essential medicines program implementation, hypertension control program administration, drug treatment and monitoring costs, disease-related costs, and quality-adjusted life years (QALYs) gained by preventing cardiovascular disease or lost because of drug side effects in untreated hypertensive adults aged 35–84 y over 2015–2025. Cost-effectiveness was assessed in cardiovascular disease patients (secondary prevention) and for two blood pressure ranges in primary prevention (stage one, 140–159/90–99 mm Hg; stage two, ≥160/≥100 mm Hg). Treatment of isolated systolic hypertension and combined systolic and diastolic hypertension were modeled as a reduction in systolic blood pressure; treatment of isolated diastolic hypertension was modeled as a reduction in diastolic blood pressure. One-way and probabilistic sensitivity analyses explored ranges of antihypertensive drug effectiveness and costs, monitoring frequency, medication adherence, side effect severity, background hypertension prevalence, antihypertensive medication treatment, case fatality, incidence and prevalence, and cardiovascular disease treatment costs. Median antihypertensive costs from Shanghai and Yunnan province were entered into the model in order to estimate the effects of very low and high drug prices. Incremental cost-effectiveness ratios less than the per capita gross domestic product of China (11,900 international dollars [Int$] in 2015) were considered cost-effective. Treating hypertensive adults with prior cardiovascular disease for secondary prevention was projected to be cost saving in the main simulation and 100$13,000 per QALY gained [95% uncertainty interval, Int$10,000 to Int$18,000]). Of all one-way sensitivity analyses, assuming adherence to taking medications as low as 25%, high Shanghai drug costs, or low medication efficacy led to the most unfavorable results (treating all hypertension, about Int$47,000, Int$37,000, and Int$27,000 per QALY were gained, respectively). The strengths of this study were the use of a recent Chinese national health survey, vital statistics, health care costs, and cohort study outcomes data as model inputs and reliance on clinical-trial-based estimates of coronary heart disease and stroke risk reduction due to antihypertensive medication treatment. The limitations of the study were the use of several sources of data, limited clinical trial evidence for medication effectiveness and harms in the youngest and oldest age groups, lack of information about geographic and ethnic subgroups, lack of specific information about indirect costs borne by patients, and uncertainty about the future epidemiology of cardiovascular diseases in China.</p><p>Conclusions</p><p>Expanded hypertension treatment has the potential to prevent about 800,000 cardiovascular disease events annually and be borderline cost-effective in China, provided low-cost essential antihypertensive medicines programs can be implemented.</p></div

CVD Policy Model-China structure.

<p>State transitions are numbered in the diagram. Transition 1 = remain in CVD-free state. Transition 2 = incident CVD. Transition 3 = non-CVD death. Transitions 4 and 5 = survival or case fatality. Transition 6 = survival with or without repeat CVD event in chronic CVD patients.</p

One-way sensitivity analysis of hypertension treatment inputs.

<p>* WHO CHOICE lowest outpatient visit cost for China</p><p>^† Stage two twice yearly, stage one once yearly</p><p>^‡ Stage two four times yearly, stage one three times yearly</p><p>^Δ Less than 1 x China’s 2015 GDP per capita (</p><p>^§ Less than 2 x China’s 2015 GDP per capita and greater than 1 x GDP per capita (≥Int$11,906 and < Int$23,812)</p><p>**Less than 3 x China’s GDP per capita and greater than 2 x GDP per capita (≥Int$23,812 and </p><p>^¶ Greater than 3 x China’s GDP per capita (≥Int$35,718)</p><p>All estimates are ICERs, compared with the prior strategy. Results are in 2015 international dollars (2015 Chinese RMB). All results reported as cost saving describe strategies projected to be less costly and more effective than the prior strategy.</p

Effectiveness and cost-effectiveness of implementing different BP control guidelines in untreated Chinese adults aged 35–84 y with hypertension, averaged from the projections for 2015–2025, the CVD Policy Model-China.

<p>* All guideline strategies affect adults not previously treated for hypertension only, i.e., “aware/treated/uncontrolled” population not treated.</p><p>^† To convert cost input to Chinese currency, multiply by PPP rate (in this case, 3.52). To convert to $US using the current official exchange rate, multiply by (PPP/exchange rate), for example, 3.52/6.20, or by 5.68.</p><p>^§ Less than 2 x China’s GDP per capita.</p><p>Each successive strategy is compared with the prior strategy. Results are in 2015 international dollars and 2015 Chinese RMB. All results reported as cost-saving describe strategies projected to be less costly and more effective than the prior strategy. Ninety-five percent uncertainty intervals were calculated from the results of 1,000 probabilistic simulations.</p