16-OR: Cost-Effectiveness of the 2017 Hypertension Guidelines among U.S. Adults with Diabetes—Results from a Simulation Study

In 2017, the American College of Cardiology (ACC) and American Heart Association (AHA) changed their guideline for defining hypertension by lowering the blood pressure level threshold from ≥140/90 mmHg to ≥130/80 mmHg. For adults with diabetes and hypertension, initiation of antihypertensive drug treatment was recommended. We used the 2017-March 2020 National Health and Nutrition Examination Survey to create a nationally representative sample of people with diabetes. We used a new diabetes microsimulation model developed by CDC and RTI international to project the lifetime health and cost consequences of implementing this guideline. Hypertension treatments specified in the study follow the guideline. The cost-effectiveness (CE) from a health care system perspective was measured by the incremental CE ratio in terms of cost per quality-adjusted life year (QALY). Under the new guideline, the number of persons with diabetes eligible for treatment would increase from 11.3 million to 20.1 million. Treating these additional patients would increase QALYs by 189,000 and reduce health care cost by $50.7 billion in lifetime. Cost-saving results holds for all subgroups examined (Table). The 2017ACC/AHA guideline yields an additional nearly 9 million people with diabetes recommended for hypertension treatment. Treating this newly eligible population would be cost-saving.