26 research outputs found
Recommended from our members
Cost-Effectiveness of Hypertension Therapy According to 2014 Guidelines
BACKGROUND: On the basis of the 2014 guidelines for hypertension therapy in the United States, many eligible adults remain untreated. We projected the cost-effectiveness of treating hypertension in U.S. adults according to the 2014 guidelines.
METHODS: We used the Cardiovascular Disease Policy Model to simulate drug-treatment and monitoring costs, costs averted for the treatment of cardiovascular disease, and quality-adjusted life-years (QALYs) gained by treating previously untreated adults between the ages of 35 and 74 years from 2014 through 2024. We assessed cost-effectiveness according to age, hypertension level, and the presence or absence of chronic kidney disease or diabetes.
RESULTS: The full implementation of the new hypertension guidelines would result in approximately 56,000 fewer cardiovascular events and 13,000 fewer deaths from cardiovascular causes annually, which would result in overall cost savings. The projections showed that the treatment of patients with existing cardiovascular disease or stage 2 hypertension would save lives and costs for men between the ages of 35 and 74 years and for women between the ages of 45 and 74 years. The treatment of men or women with existing cardiovascular disease or men with stage 2 hypertension but without cardiovascular disease would remain cost-saving even if strategies to increase medication adherence doubled treatment costs. The treatment of stage 1 hypertension was cost-effective (defined as <$50,000 per QALY) for all men and for women between the ages of 45 and 74 years, whereas treating women between the ages of 35 and 44 years with stage 1 hypertension but without cardiovascular disease had intermediate or low cost-effectiveness.
CONCLUSIONS: The implementation of the 2014 hypertension guidelines for U.S. adults between the ages of 35 and 74 years could potentially prevent about 56,000 cardiovascular events and 13,000 deaths annually, while saving costs. Controlling hypertension in all patients with cardiovascular disease or stage 2 hypertension could be effective and cost-saving. (Funded by the National Heart, Lung, and Blood Institute and others.
Recommended from our members
OddenMichellePHHSCost-EffectivenessHypertension_SupplementaryAppendix.pdf
BACKGROUND: On the basis of the 2014 guidelines for hypertension therapy in the United States,
many eligible adults remain untreated. We projected the cost-effectiveness of treating
hypertension in U.S. adults according to the 2014 guidelines.
METHODS: We used the Cardiovascular Disease Policy Model to simulate drug-treatment and
monitoring costs, costs averted for the treatment of cardiovascular disease, and
quality-adjusted life-years (QALYs) gained by treating previously untreated adults
between the ages of 35 and 74 years from 2014 through 2024. We assessed cost-effectiveness
according to age, hypertension level, and the presence or absence of
chronic kidney disease or diabetes.
RESULTS: The full implementation of the new hypertension guidelines would result in approximately
56,000 fewer cardiovascular events and 13,000 fewer deaths from cardiovascular
causes annually, which would result in overall cost savings. The projections
showed that the treatment of patients with existing cardiovascular disease or
stage 2 hypertension would save lives and costs for men between the ages of 35 and
74 years and for women between the ages of 45 and 74 years. The treatment of men
or women with existing cardiovascular disease or men with stage 2 hypertension
but without cardiovascular disease would remain cost-saving even if strategies to
increase medication adherence doubled treatment costs. The treatment of stage 1
hypertension was cost-effective (defined as <$50,000 per QALY) for all men and for
women between the ages of 45 and 74 years, whereas treating women between the
ages of 35 and 44 years with stage 1 hypertension but without cardiovascular disease
had intermediate or low cost-effectiveness.
CONCLUSIONS: The implementation of the 2014 hypertension guidelines for U.S. adults between the
ages of 35 and 74 years could potentially prevent about 56,000 cardiovascular events
and 13,000 deaths annually, while saving costs. Controlling hypertension in all
patients with cardiovascular disease or stage 2 hypertension could be effective and
cost-saving. (Funded by the National Heart, Lung, and Blood Institute and others.
Recommended from our members
OddenMichellePHHSCost-EffectivenessHypertension.pdf
BACKGROUND: On the basis of the 2014 guidelines for hypertension therapy in the United States,
many eligible adults remain untreated. We projected the cost-effectiveness of treating
hypertension in U.S. adults according to the 2014 guidelines.
METHODS: We used the Cardiovascular Disease Policy Model to simulate drug-treatment and
monitoring costs, costs averted for the treatment of cardiovascular disease, and
quality-adjusted life-years (QALYs) gained by treating previously untreated adults
between the ages of 35 and 74 years from 2014 through 2024. We assessed cost-effectiveness
according to age, hypertension level, and the presence or absence of
chronic kidney disease or diabetes.
RESULTS: The full implementation of the new hypertension guidelines would result in approximately
56,000 fewer cardiovascular events and 13,000 fewer deaths from cardiovascular
causes annually, which would result in overall cost savings. The projections
showed that the treatment of patients with existing cardiovascular disease or
stage 2 hypertension would save lives and costs for men between the ages of 35 and
74 years and for women between the ages of 45 and 74 years. The treatment of men
or women with existing cardiovascular disease or men with stage 2 hypertension
but without cardiovascular disease would remain cost-saving even if strategies to
increase medication adherence doubled treatment costs. The treatment of stage 1
hypertension was cost-effective (defined as <$50,000 per QALY) for all men and for
women between the ages of 45 and 74 years, whereas treating women between the
ages of 35 and 44 years with stage 1 hypertension but without cardiovascular disease
had intermediate or low cost-effectiveness.
CONCLUSIONS: The implementation of the 2014 hypertension guidelines for U.S. adults between the
ages of 35 and 74 years could potentially prevent about 56,000 cardiovascular events
and 13,000 deaths annually, while saving costs. Controlling hypertension in all
patients with cardiovascular disease or stage 2 hypertension could be effective and
cost-saving. (Funded by the National Heart, Lung, and Blood Institute and others.
Recommended from our members
OddenMichellePHHSCost-EffectivenessHypertension_DisclosureForms.pdf
BACKGROUND: On the basis of the 2014 guidelines for hypertension therapy in the United States,
many eligible adults remain untreated. We projected the cost-effectiveness of treating
hypertension in U.S. adults according to the 2014 guidelines.
METHODS: We used the Cardiovascular Disease Policy Model to simulate drug-treatment and
monitoring costs, costs averted for the treatment of cardiovascular disease, and
quality-adjusted life-years (QALYs) gained by treating previously untreated adults
between the ages of 35 and 74 years from 2014 through 2024. We assessed cost-effectiveness
according to age, hypertension level, and the presence or absence of
chronic kidney disease or diabetes.
RESULTS: The full implementation of the new hypertension guidelines would result in approximately
56,000 fewer cardiovascular events and 13,000 fewer deaths from cardiovascular
causes annually, which would result in overall cost savings. The projections
showed that the treatment of patients with existing cardiovascular disease or
stage 2 hypertension would save lives and costs for men between the ages of 35 and
74 years and for women between the ages of 45 and 74 years. The treatment of men
or women with existing cardiovascular disease or men with stage 2 hypertension
but without cardiovascular disease would remain cost-saving even if strategies to
increase medication adherence doubled treatment costs. The treatment of stage 1
hypertension was cost-effective (defined as <$50,000 per QALY) for all men and for
women between the ages of 45 and 74 years, whereas treating women between the
ages of 35 and 44 years with stage 1 hypertension but without cardiovascular disease
had intermediate or low cost-effectiveness.
CONCLUSIONS: The implementation of the 2014 hypertension guidelines for U.S. adults between the
ages of 35 and 74 years could potentially prevent about 56,000 cardiovascular events
and 13,000 deaths annually, while saving costs. Controlling hypertension in all
patients with cardiovascular disease or stage 2 hypertension could be effective and
cost-saving. (Funded by the National Heart, Lung, and Blood Institute and others.
Young Adult Exposure to Cardiovascular Risk Factors and Risk of Events Later in Life: The Framingham Offspring Study.
BACKGROUND:It is unclear whether coronary heart disease (CHD) risk factor exposure during early adulthood contributes to CHD risk later in life. Our objective was to analyze whether extent of early adult exposures to systolic and diastolic blood pressure (SBP, DBP) and low-and high-density lipoprotein cholesterol (LDL, HDL) are independent predictors of CHD events later in life. METHODS AND FINDINGS:We used all available measurements of SBP, DBP, LDL, and HDL collected over 40 years in the Framingham Offspring Study to estimate risk factor trajectories, starting at age 20 years, for all participants. Average early adult (age 20-39) exposure to each risk factor was then estimated, and used to predict CHD events (myocardial infarction or CHD death) after age 40, with adjustment for risk factor exposures later in life (age 40+). 4860 participants contributed an average of 6.3 risk factor measurements from in-person examinations and 24.5 years of follow-up after age 40, and 510 had a first CHD event. Early adult exposures to high SBP, DBP, LDL or low HDL were associated with 8- to 30-fold increases in later life CHD event rates, but were also strongly correlated with risk factor levels later in life. After adjustment for later life levels and other risk factors, early adult DBP and LDL remained strongly associated with later life risk. Compared with DBP≤70 mmHg, adjusted hazard ratios (HRs) were 2.1 (95% confidence interval: 0.8-5.7) for DBP = 71-80, 2.6 (0.9-7.2) for DBP = 81-90, and 3.6 (1.2-11) for DBP>90 (p-trend = 0.019). Compared with LDL≤100 mg/dl, adjusted HRs were 1.5 (0.9-2.6) for LDL = 101-130, 2.2 (1.2-4.0) for LDL = 131-160, and 2.4 (1.2-4.7) for LDL>160 (p-trend = 0.009). While current levels of SBP and HDL were also associated with CHD events, we did not detect an independent association with early adult exposure to either of these risk factors. CONCLUSIONS:Using a mixed modeling approach to estimation of young adult exposures with trajectory analysis, we detected independent associations between estimated early adult exposures to non-optimal DBP and LDL and CHD events later in life
Characteristics of participants at the beginning of follow up, stratified by early life exposure to LDL.
<p>Characteristics of participants at the beginning of follow up, stratified by early life exposure to LDL.</p
Coronary Heart Disease Events in Framingham Participants with Differing Exposure to Risk Factors During Young Adulthood.
<p>Coronary Heart Disease Events in Framingham Participants with Differing Exposure to Risk Factors During Young Adulthood.</p
Young Adult Exposure to Cardiovascular Risk Factors and Risk of Events Later in Life: The Framingham Offspring Study
<div><p>Background</p><p>It is unclear whether coronary heart disease (CHD) risk factor exposure during early adulthood contributes to CHD risk later in life. Our objective was to analyze whether extent of early adult exposures to systolic and diastolic blood pressure (SBP, DBP) and low-and high-density lipoprotein cholesterol (LDL, HDL) are independent predictors of CHD events later in life.</p><p>Methods and Findings</p><p>We used all available measurements of SBP, DBP, LDL, and HDL collected over 40 years in the Framingham Offspring Study to estimate risk factor trajectories, starting at age 20 years, for all participants. Average early adult (age 20–39) exposure to each risk factor was then estimated, and used to predict CHD events (myocardial infarction or CHD death) after age 40, with adjustment for risk factor exposures later in life (age 40+). 4860 participants contributed an average of 6.3 risk factor measurements from in-person examinations and 24.5 years of follow-up after age 40, and 510 had a first CHD event. Early adult exposures to high SBP, DBP, LDL or low HDL were associated with 8- to 30-fold increases in later life CHD event rates, but were also strongly correlated with risk factor levels later in life. After adjustment for later life levels and other risk factors, early adult DBP and LDL remained strongly associated with later life risk. Compared with DBP≤70 mmHg, adjusted hazard ratios (HRs) were 2.1 (95% confidence interval: 0.8–5.7) for DBP = 71–80, 2.6 (0.9–7.2) for DBP = 81–90, and 3.6 (1.2–11) for DBP>90 (p-trend = 0.019). Compared with LDL≤100 mg/dl, adjusted HRs were 1.5 (0.9–2.6) for LDL = 101–130, 2.2 (1.2–4.0) for LDL = 131–160, and 2.4 (1.2–4.7) for LDL>160 (p-trend = 0.009). While current levels of SBP and HDL were also associated with CHD events, we did not detect an independent association with early adult exposure to either of these risk factors.</p><p>Conclusions</p><p>Using a mixed modeling approach to estimation of young adult exposures with trajectory analysis, we detected independent associations between estimated early adult exposures to non-optimal DBP and LDL and CHD events later in life.</p></div
Framingham Offspring Study Sample Examinations and Observation Period.
<p>Framingham Offspring Study Sample Examinations and Observation Period.</p