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Cost-effectiveness of a hypertension management programme in an elderly population: a Markov model

Gastón Perman1,2*, Emiliano Rossi1, Gabriel D Waisman3, Cristina Agüero4, Claudio D González5, Carlos L Pallordet6, Silvana Figar2, Fernán González Bernaldo de Quirós7, JoAnn Canning8 and Enrique R Soriano8

Author Affiliations

1 Medical Programmes, Hospital Italiano de Buenos Aires, (Perón 4253, 2°), Ciudad de Buenos Aires, (C1199ABC), Argentina

2 Epidemiology Section, Internal Medicine Department, Hospital Italiano de Buenos Aires, (Perón 4253, 2°), Ciudad de Buenos Aires, (C1199ABC), Argentina

3 Hypertension Section, Internal Medicine Department, Hospital Italiano de Buenos Aires, (Perón 4190, 2°), Ciudad de Buenos Aires, (C1199ABB), Argentina

4 Financial Department, Hospital Italiano de Buenos Aires, (Perón 4253, 2°), Ciudad de Buenos Aires, (C1199ABC), Argentina

5 Pharmacology Department, School of Medicine, Universidad Austral, (Perón 1500), Derqui, (B1629AHJ), Provincia de Buenos Aires, Argentina

6 Fundación Capital, (Sinclair 3088), Ciudad de Buenos Aires, (C1425FRD), Argentina

7 Strategic Management, Hospital Italiano de Buenos Aires, (Perón 4190, PB), Ciudad de Buenos Aires, (C1199ABB), Argentina

8 Health Informatics Department, Hospital Italiano de Buenos Aires, (Perón 4272, 3°), Ciudad de Buenos Aires, (C1199ABD), Argentina

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Cost Effectiveness and Resource Allocation 2011, 9:4 doi:10.1186/1478-7547-9-4

Published: 5 April 2011

Abstract

Background

Mounting evidence shows that multi-intervention programmes for hypertension treatment are more effective than an isolated pharmacological strategy. Full economic evaluations of hypertension management programmes are scarce and contain methodological limitations. The aim of the study was to evaluate if a hypertension management programme for elderly patients is cost-effective compared to usual care from the perspective of a third-party payer.

Methods

We built a cost-effectiveness model using published evidence of effectiveness of a comprehensive hypertension programme vs. usual care for patients 65 years or older at a community hospital in Buenos Aires, Argentina. We explored incremental cost-effectiveness between groups. The model used a life-time framework adopting a third-party payer's perspective. Incremental cost-effectiveness ratio (ICER) was calculated in International Dollars per life-year gained. We performed a probabilistic sensitivity analysis (PSA) to explore variable uncertainty.

Results

The ICER for the base-case of the "Hypertension Programme" versus the "Usual care" approach was 1,124 International Dollars per life-year gained. PSA did not significantly influence results. The programme had a probability of 43% of being dominant (more effective and less costly) and, overall, 95% chance of being cost-effective.

Discussion

Results showed that "Hypertension Programme" had high probabilities of being cost-effective under a wide range of scenarios. This is the first sound cost-effectiveness study to assess a comprehensive hypertension programme versus usual care. This study measures hard outcomes and explores robustness through a probabilistic sensitivity analysis.

Conclusions

The comprehensive hypertension programme had high probabilities of being cost-effective versus usual care. This study supports the idea that similar programmes could be the preferred strategy in countries and within health care systems where hypertension treatment for elderly patients is a standard practice.