Why the study?
While South Korea uses the KSH threshold of 140/90 mmHg, the 2017 ACC/AHA guidelines lowered the threshold to 130/80 mmHg, prompting evaluation of the cost-effectiveness of transitioning guidelines.
Does adopting the 2017 ACC/AHA hypertension guidelines (target <130/80 mmHg) improve cost-effectiveness compared to the KSH guidelines (target <140/90 mmHg) in South Korean adults?
Does adopting the 2017 ACC/AHA hypertension guidelines (target <130/80 mmHg) improve cost-effectiveness compared to the KSH guidelines (target <140/90 mmHg) in South Korean adults?
Adopting the stricter 2017 ACC/AHA blood pressure targets (<130/80 mmHg) is highly cost-effective across all adult age groups in South Korea compared to the standard <140/90 mmHg target.
Supports updating South Korean guidelines to <130/80 mmHg targets; extends US cost-effectiveness findings to Asian adults.
BACKGROUND: Hypertension is a significant risk factor for cardiovascular disease (CVD), with hypertension-related deaths increasing annually. While South Korea uses the Korean Society of Hypertension (KSH) guideline of 140/90 mmHg, the American College of Cardiology (ACC) and American Heart Association (AHA) updated their guidelines in 2017 to 130/80 mmHg. This study evaluates the cost-effectiveness of transitioning to the 2017 ACC/AHA guidelines by estimating early treatment impacts and potential CVD risk reduction. METHODS: A Markov state-transition simulation model with a 10-year horizon was used to estimate cost-effectiveness, focusing on strengthening target blood pressure. Quality-adjusted life years (QALYs) served as the measure of effectiveness. Cohorts of 10,000 individuals representing South Koreans in their 20s through 80s were compared in scenario analyses from the healthcare system perspective. A 4.5% annual discount rate was applied to costs and effectiveness. Primary outcomes were incremental cost-effectiveness ratio (ICER) and net monetary benefit (NMB). The willingness-to-pay (WTP) threshold was < KRW 30,000,000/QALY gained. Probabilistic sensitivity analyses (PSAs) addressed model input parameter uncertainties. RESULTS: The base-case analysis showed an ICER value of KRW 1,328,395/QALY gained across all populations. ICER values increased with age, from - KRW 3,138,071/QALY for 20-year-olds to KRW 16,613,013/QALY for individuals over 80. The 60s age group showed the greatest benefit with an incremental QALY gain of 0.46. All scenarios had ICERs below the WTP threshold, with a PSA probability of 98.0% that strengthening blood pressure classification could be cost-effective. CONCLUSIONS: This economic evaluation found that adopting the 2017 ACC/AHA guidelines may result in early treatment, reduce the potential incidence of CVD events, and be cost-effective across all age groups. The study findings have implications for policymakers deciding whether and when to revise official guidelines regarding target blood pressure levels, considering the impacts on public health and budgetary concerns.
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Kim et al. (2024) studied Hypertension (n=10,000). 2017 ACC/AHA guidelines (target <130/80 mmHg) vs. KSH guidelines (target <140/90 mmHg) was evaluated on Incremental cost-effectiveness ratio (ICER) (ICER KRW 1,328,395/QALY). Adopting the 2017 ACC/AHA hypertension guidelines was cost-effective across all age groups, yielding a base-case incremental cost-effectiveness ratio of KRW 1,328,395 per QALY gained.
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