Table 3. One-way sensitivity analysis of hypertension treatment inputs.
All estimates are ICERs, compared with the prior strategy. Results are in 2015 international dollars (2015 Chinese RMB). All results reported as cost saving describe strategies projected to be less costly and more effective than the prior strategy.
| Strategy | Strategy 1: Treat all stage two hypertension patients to goal of <140/90 if age 35–64 y, goal of 150/90 if age ≥65, in addition to CVD patients | Strategy 2: Treat stage two and stage one, goal <140/90 if age 35–64 y, goal of 150/90 if age ≥65, in addition to CVD patients |
|---|---|---|
| Comparator for ICER | Treat only CVD patients (base case) | Strategy 1 |
| Main assumptions simulations | Int$9,000 (¥32,000)Δ | Int$13,000 (¥47,000)§ |
| Assume higher CVD incidence | Int$7,000 (¥26,000)Δ | Int$10,000 (¥37,000)Δ |
| Sex | ||
| Males | Int$7,000 (¥24,000)Δ | Int$12,000 (¥41,000)Δ |
| Females | Int$12,000 (¥44,000)Δ | Int$15,000 (¥54,000)§ |
| Relative risk with change in BP | ||
| Lower 95% confidence interval of RRs | Int$17,000 (¥61,000)Δ | Int$15,000 (¥53,000)Δ |
| Upper 95% confidence interval of RRs | Int$5,000 (¥18,000)Δ | Int$12,000 (¥42,000)§ |
| Range in efficacy of antihypertensive agents (change in BP with treatment) | ||
| Upper | Int$7,000 (¥23,000)Δ | Int$8,000 (¥29,000)Δ |
| Lower | Int$14,000 (¥49,000)Δ | Int$27,900 (¥96,000)** |
| Adherence to any pharmaceutical therapy | ||
| 75% | Int$7,000 (¥25,000)Δ | Int$14,000 (¥49,000)§ |
| 25% | Int$25,000 (¥87,000)** | Int$47,000 (¥165,000)¶ |
| Range of severity of side effects of antihypertensive medications | ||
| Upper | Int$9,000 (¥32,000)Δ | Int$14,000 (¥ 48,000)§ |
| Lower | Int$600 (¥2,000)Δ | Int$13,000 (¥ 46,000)Δ |
| Range of drug costs | ||
| Low cost: Average of lowest national essential medicines costs per antihypertensive class | Int$8,000 (¥27,000)Δ | Int$10,000 (¥131,000)Δ |
| Lowest cost: Average of median costs per antihypertensive class, Yunnan province essential medicines list | Int$9,000 (¥31,000)Δ | Int$12,000 (¥34,000)Δ |
| High cost: Average of median costs per antihypertensive class, Shanghai municipality essential medicines list | Int$19,000 (¥67,000)§ | Int$37,000 (¥131,000)¶ |
| Range of monitoring costs | ||
| Lower monitoring cost* | Int$8,000 (¥31,000)Δ | Int$12,000 (¥42,000)Δ |
| Less frequent monitoring† | Int$8,000 (¥29,000)Δ | Int$10,000 (¥35,000)Δ |
| Higher monitoring cost | Int$9,000 (¥32,000)Δ | Int$14,000 (¥48,000)§ |
| More frequent monitoring‡ | Int$10,000 (¥34,000)Δ | Int$21,000 (¥75,000)§ |
| Hypothetical cost scenarios | ||
| Increase hypertension treatment costs 10% | Int$10,000 (¥34,000)Δ | Int$15,000 (¥53,000)§ |
| Increase CVD treatment costs 50% | Int$7,000 (¥24,000)Δ | Int$11,000 (¥40,000)Δ |
| Increase both cost inputs above | Int$7,000 (¥26,000)Δ | Int$13,000 (¥46,000)Δ |
| Without costs of screening, program administration, or implementation (medication, monitoring, and side effect costs only) | Cost-saving | Int$12,000 (¥42,000)Δ |
* WHO CHOICE lowest outpatient visit cost for China
† Stage two twice yearly, stage one once yearly
‡ Stage two four times yearly, stage one three times yearly
Δ Less than 1 x China’s 2015 GDP per capita (<Int$11,900; international dollars)
§ Less than 2 x China’s 2015 GDP per capita and greater than 1 x GDP per capita (≥Int$11,906 and < Int$23,812)
**Less than 3 x China’s GDP per capita and greater than 2 x GDP per capita (≥Int$23,812 and <Int$35,718)
¶ Greater than 3 x China’s GDP per capita (≥Int$35,718)