Abstract 16725: Cost-Effectiveness Analysis of Intensive Treatment of Systolic Hypertension: Results From Sprint Patient-Level Data

Background: The Systolic Blood Pressure Intervention Trial (SPRINT) showed that treating patients at high risk for cardiovascular events but without diabetes or a history of stroke to a systolic blood pressure (SBP) target goal of <120 mm Hg (Intensive Care, IC), compared with <140 mm Hg (Standard Care, SC), resulted in lower rates of fatal and nonfatal major cardiovascular events and death. We examined the cost-effectiveness of IC vs SC over a life-time horizon, based on patient-level data, from a health-sector perspective.

Methods: Patient-level data from SPRINT were used to calculate and estimate cost, effectiveness, quality adjusted life years (QALY), and the incremental cost-effectiveness ratio (ICER). For participants who died during the trial, life years and QALYs were estimated from in-trial analysis; for who survived to the end of the trial, pooled, harmonized data from six epidemiologic cohorts included in the National Heart, Lung, and Blood Institute Pooled Cohorts Study was used to estimate risk of lifetime primary fatal and non-fatal events and calculate life-years. Published utilities estimates were used to calculate QALYs. For participants without SPRINT lifetime primary event estimates, we applied multiple imputation method via machine learning to impute the life-years and QALYs. The ICER was expressed as cost per QALY gained.

Results: IC participants were estimated to gain an average of 0.51 QALY (95% CI: 0.21, 0.81) relative to SC participants. Estimated total lifetime costs were $17,449 higher with IC (95% CI: $10,697, $24,201) than SC. The ICER for IC vs SC was $34,214 per QALY gained, with 68.5% of bootstrap-derived estimates <$50,000/QALY. The results from multiple imputation chained equations for addressing missing data showed that IC is cost effectiveness at $50,000/QALY. Across various scenario analyses, we consistently found a more than 60% probability that IC is cost-effective over a lifetime when the willingness-to-pay value exceeds $100,000 per QALY.

Conclusions: Based on participant-level trial and epidemiologic cohort data, IC is cost-effective, with significant clinical benefit at acceptable higher lifetime cost. Recommending intensive SBP targets in patients at high CVD risk is an effective, high-value therapy.