Treating Mild Chronic Hypertension During Pregnancy: A Cost-Effectiveness Analysis.
Journal
Obstetrics and gynecology
ISSN: 1873-233X
Titre abrégé: Obstet Gynecol
Pays: United States
ID NLM: 0401101
Informations de publication
Date de publication:
22 Feb 2024
22 Feb 2024
Historique:
received:
28
09
2023
accepted:
07
12
2023
medline:
22
2
2024
pubmed:
22
2
2024
entrez:
22
2
2024
Statut:
aheadofprint
Résumé
To assess the cost effectiveness of targeting a blood pressure of less than 140/90 mm Hg compared with 160/105 mm Hg. A decision-analytic model was constructed to compare the treatment of chronic hypertension in pregnancy at mild-range blood pressures (140/90 mm Hg) with the treatment of chronic hypertension before 20 weeks of gestation at severe-range blood pressures (160/105 mm Hg) in a theoretical cohort of 180,000 patients with mild chronic hypertension. Probabilities, costs, and utilities were derived from literature and varied in sensitivity analyses. Primary outcomes included incremental cost per quality-adjusted life-year (QALY), cases of preeclampsia, preeclampsia with severe features, severe maternal morbidity (SMM), preterm birth, maternal death, neonatal death, and neurodevelopmental delay. The cost-effectiveness threshold was $100,000 per QALY. Treating chronic hypertension in a population of 180,000 pregnant persons at mild-range blood pressures, compared with severe-range blood pressures, resulted in 14,177 fewer cases of preeclampsia (43,953 vs 58,130), 11,835 of which were cases of preeclampsia with severe features (40,530 vs 52,365). This led to 817 fewer cases of SMM (4,375 vs 5,192), and 18 fewer cases of maternal death (102 vs 120). Treating at a lower threshold also resulted in 8,078 fewer cases of preterm birth (22,000 vs 30,078), which led to 26 fewer neonatal deaths (276 vs 302) and 157 fewer cases of neurodevelopmental delay (661 vs 818). Overall, treating chronic hypertension at a lower threshold was a dominant strategy that resulted in decreased costs of $600 million and increased effectiveness of 12,852 QALYs. Treating chronic hypertension at a threshold of mild-range blood pressures is a dominant (lower costs, better outcomes) and cost-effective strategy that results in fewer neonatal and maternal deaths compared with the standard treatment of treating at severe range blood pressures.
Identifiants
pubmed: 38387029
doi: 10.1097/AOG.0000000000005531
pii: 00006250-990000000-01027
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
Copyright © 2024 by the American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
Financial Disclosure The authors did not report any potential conflicts of interest.
Références
Tita AT, Szychowski JM, Boggess K, Dugoff L, Sibai B, Lawrence K, et al. Treatment for mild chronic hypertension during pregnancy. N Engl J Med 2022;386:1781–92. doi: 10.1056/NEJMoa2201295
doi: 10.1056/NEJMoa2201295
Bateman BT, Bansil P, Hernandez-Diaz S, Mhyre JM, Callaghan WM, Kuklina EV. Prevalence, trends, and outcomes of chronic hypertension: a nationwide sample of delivery admissions. Am J Obstet Gynecol 2012;206:134.e1–8. doi: 10.1016/j.ajog.2011.10.878
doi: 10.1016/j.ajog.2011.10.878
Ananth CV, Duzyj CM, Yadava S, Schwebel M, Tita ATN, Joseph KS. Changes in the prevalence of chronic hypertension in pregnancy, United States, 1970 to 2010. Hypertension 2019;74:1089–95. doi: 10.1161/HYPERTENSIONAHA.119.12968
doi: 10.1161/HYPERTENSIONAHA.119.12968
Hypertension in pregnancy. Report of the American College of Obstetricians and Gynecologists’ Task Force on Hypertension in Pregnancy. Obstet Gynecol 2013;122:1122–31. doi: 10.1097/01.AOG.0000437382.03963.88
doi: 10.1097/01.AOG.0000437382.03963.88
Chronic hypertension in pregnancy. ACOG Practice Bulletin No. 203. American College of Obstetricians and Gynecologists. Obstet Gynecol 2019;133:e26–50. doi: 10.1097/AOG.0000000000003020
doi: 10.1097/AOG.0000000000003020
Whelton PK, Carey RM, Aronow WS, Casey DE Jr, Collins KJ, Dennison Himmelfarb C, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/AphA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension 2018;71:1269–324. doi: 10.1161/HYP.0000000000000066
doi: 10.1161/HYP.0000000000000066
Abalos E, Duley L, Steyn DW, Gialdini C. Antihypertensive drug therapy for mild to moderate hypertension during pregnancy. The Cochrane Database of Systematic Reviews 2018, Issue 10. Art. No.: CD002252. doi: 10.1002/14651858.CD002252.pub4
doi: 10.1002/14651858.CD002252.pub4
von Dadelszen P, Ornstein MP, Bull SB, Logan AG, Koren G, Magee LA. Fall in mean arterial pressure and fetal growth restriction in pregnancy hypertension: a meta-analysis. Lancet 2000;355:87–92. doi: 10.1016/s0140-6736(98)08049-0
doi: 10.1016/s0140-6736(98)08049-0
Centers for Disease Control and Prevention. Vital statistics online data portal. Accessed December 17, 2023. https://www.cdc.gov/nchs/data_access/vitalstatsonline.htm
Good Rx. Hypertension medications. Accessed December 17, 2023. https://www.goodrx.com/conditions/hypertension/drugs
Hao J, Hassen D, Hao Q, Graham J, Paglia MJ, Brown J, et al. Maternal and infant health care costs related to preeclampsia. Obstet Gynecol 2019;134:1227–33. doi: 10.1097/AOG.0000000000003581
doi: 10.1097/AOG.0000000000003581
Chung A, Macario A, El-Sayed YY, Riley ET, Duncan B, Druzin ML. Cost-effectiveness of a trial of labor after previous cesarean. Obstet Gynecol 2001;97:932–41. doi: 10.1016/s0029-7844(01)01355-2
doi: 10.1016/s0029-7844(01)01355-2
Centers for Disease Control and Prevention. Economic costs associated with mental retardation, cerebral palsy, hearing loss, and vision impairment—United States, 2003 [published erratum available at https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5532a5.htm]. Accessed December 17, 2023. https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5303a4.htm
Shmueli A, Meiri H, Gonen R. Economic assessment of screening for pre-eclampsia. Prenat Diagn 2012;32:29–38. doi: 10.1002/pd.2871
doi: 10.1002/pd.2871
Shih T, Peneva D, Xu X, Sutton A, Triche E, Ehrenkranz RA, et al. The rising burden of preeclampsia in the United States impacts both maternal and child health. Am J Perinatol 2016;33:329–38. doi: 10.1055/s-0035-1564881
doi: 10.1055/s-0035-1564881
Kuppermann M, Nease RF, Learman LA, Gates E, Blumberg B, Washington AE. Procedure-related miscarriages and down syndrome-affected births: implications for prenatal testing based on women’s preferences. Obstet Gynecol 2000;96:511–6. doi: 10.1016/s0029-7844(00)00969-8
doi: 10.1016/s0029-7844(00)00969-8
Centers for Disease Control and Prevention. Life expectancy in the U.S. dropped for the second time in 2021. Accessed December 17, 2023. https://www.cdc.gov/nchs/pressroom/nchs_press_releases/2022/20220831.htm
Park C, Wang G, Durthaler JM, Fang J. Cost-effectiveness analyses of antihypertensive medicines: a systematic review. Am J Prev Med 2017;53:S131–42. doi: 10.1016/j.amepre.2017.06.020
doi: 10.1016/j.amepre.2017.06.020
Bryant KB, Moran AE, Kazi DS, Zhang Y, Penko J, Ruiz-Negrón N, et al. Cost-effectiveness of hypertension treatment by pharmacists in Black barbershops. Circulation 2021;143:2384–94. doi: 10.1161/CIRCULATIONAHA.120.051683
doi: 10.1161/CIRCULATIONAHA.120.051683
Constanti M, Floyd CN, Glover M, Boffa R, Wierzbicki AS, McManus RJ. Cost-effectiveness of initiating pharmacological treatment in stage one hypertension based on 10-year cardiovascular disease risk: a Markov modeling study. Hypertension 2021;77:682–91. doi: 10.1161/HYPERTENSIONAHA.120.14913
doi: 10.1161/HYPERTENSIONAHA.120.14913
Liao C, Toh HS, Sun L, Yang CT, Hu A, Wei D, et al. Cost-effectiveness of intensive vs standard blood pressure control among older patients with hypertension. JAMA Netw Open 2023;6:e230708. doi: 10.1001/jamanetworkopen.2023.0708
doi: 10.1001/jamanetworkopen.2023.0708
Magee LA, von Dadelszen P, Singer J, Lee T, Rey E, Ross S, et al. The CHIPS randomized controlled trial (Control of Hypertension in Pregnancy Study): is severe hypertension just an elevated blood pressure? Hypertension 2016;68:1153–9. doi: 10.1161/HYPERTENSIONAHA.116.07862
doi: 10.1161/HYPERTENSIONAHA.116.07862
Bone JN, Khowaja AR, Vidler M, Payne BA, Bellad MB, Goudar SS, et al. Economic and cost-effectiveness analysis of the community-level interventions for pre-eclampsia (CLIP) trials in India, Pakistan and Mozambique. BMJ Glob Health 2021;6:e004123. doi: 10.1136/bmjgh-2020-004123
doi: 10.1136/bmjgh-2020-004123
Iqbal AM, Jamal SF. Essential hypertension. In: StatPearls [Internet]. Accessed December 17, 2023. https://www.ncbi.nlm.nih.gov/books/NBK539859/
California birth data 2011-2018. Accessed June 15, 2022. https://www.cdph.ca.gov/Programs/CHSI/Pages/Data-Applications.aspx
Hoyert DL. Maternal mortality rates in the United States, 2021. NCHS Health E-Stats 2023;1–5. doi: 10.15620/cdc:124678
doi: 10.15620/cdc:124678
Pulver LS, Guest-Warnick G, Stoddard GJ, Byington CL, Young PC. Weight for gestational age affects the mortality of late preterm infants. Pediatrics 2009;123:e1072–7. doi: 10.1542/peds.2008-3288
doi: 10.1542/peds.2008-3288
Phibbs CS, Schmitt SK. Estimates of the cost and length of stay changes that can be attributed to one-week increases in gestational age for premature infants. Early Hum Dev 2006;82:85–95. doi: 10.1016/j.earlhumdev.2006.01.001
doi: 10.1016/j.earlhumdev.2006.01.001
Vesco KK, Ferrante S, Chen Y, Rhodes T, Black CM, Allen-Ramey F. Costs of severe maternal morbidity during pregnancy in US commercially insured and Medicaid populations: an observational study. Matern Child Health J 2020;24:30–8. doi: 10.1007/s10995-019-02819-z
doi: 10.1007/s10995-019-02819-z
Carroll AE, Downs SM. Improving decision analyses: parent preferences (utility values) for pediatric health outcomes. J Pediatr 2009;155:21–5, 25.e1–5. doi: 10.1016/j.jpeds.2009.01.040
doi: 10.1016/j.jpeds.2009.01.040