What is the clinical evidence from this study?

Study design: Other. Population: Hypertension (n=38006). Intervention: Lifestyle management combined with statin treatment vs. No intervention. Primary outcome: Incremental cost-effectiveness ratio (ICER) per QALY gained.

May 13, 2025Open Access

Cost-effectiveness of cardiovascular risk assessment and management among adults with hypertension in China: A modelling study

Key Result

Lifestyle management combined with statin treatment in hypertensive individuals aged ≥ 35 years was highly cost-effective, yielding an ICER of $1219.76 per QALY gained compared to no intervention.

Structured PICO

Does statin treatment with or without lifestyle management improve health outcomes and provide cost-effective cardiovascular risk reduction in Chinese hypertensive patients aged ≥35 years?

Population

Chinese hypertensive patients aged ≥35 years with high cardiovascular risk

Intervention

Statin treatment alone or lifestyle management combined with statin treatment

Comparator

No intervention

Outcome

Health benefits (stroke/myocardial infarction incidence, all-cause mortality) and incremental cost-effectiveness ratios ($/quality-adjusted life-year)

Cardiovascular risk assessment and combined management with statins and lifestyle modifications is a highly cost-effective strategy for preventing cardiovascular disease in Chinese adults with hypertension.

Limitations

Assumed relative risks and side effects for various outcomes were the same for all age groups, potentially underestimating health benefits and overestimating ICER for younger patients.
Indirect costs, such as productivity or family long-term care costs, were not included in the analysis.
Some model inputs were derived from a large cohort study in northern China and might not be fully representative of the general Chinese population.
Specific numbers may not be directly extrapolated to other populations due to varying treatment costs and event transition probabilities across different countries.

Abstract

Objective: Blood pressure reduction alone is insufficient for significant cardiovascular risk improvement in patients with hypertension. Cardiovascular risk assessment and management are recommended to prevent and control cardiovascular diseases (CVD), but their cost-effectiveness in real-world Chinese settings is unclear. This study evaluated the benefits and cost-effectiveness of two strategies based on cardiovascular risk in Chinese hypertensive patients aged ≥35 years: statin treatment and lifestyle management + statin treatment. Methods: A decision-analytic Markov cohort model was constructed to estimate health benefits and incremental cost-effectiveness ratios between two interventions and no intervention over 10-year and lifetime horizons. Parameters including stroke/myocardial infarction (MI) incidence, all-cause mortality, costs, and health utilities were extracted from the Kailuan study, published literature, or public datasets. Sensitivity analyses assessed the influence of parameter uncertainty on the results of base-case analysis. Results: Statin treatment alone in hypertensive patients with high cardiovascular risk was projected to avert 847, 350 stroke cases, 1412, 250 MI cases and 564, 900 all-cause deaths over a 10-year time horizon. Lifestyle management combined with statin treatment could prevent more cardiovascular and death events and was highly cost-effective (1219. 76/quality-adjusted life-year vs. gross domestic product per capita 12, 680. 83). Over a lifetime horizon, it was highly cost-effective regardless of the age when the combined intervention was started, with earlier initiation yielding greater benefits in preventing cardiovascular events. Sensitivity analyses confirmed robust results. Conclusion: Cardiovascular risk assessment and combined management in hypertensive individuals aged ≥35 years would generate substantial health gains and represent a highly cost-effective CVD prevention strategy in China.

Bookmark

View Full Paper