Figure 2. Incidence Rate Ratios for the Primary Outcome and Incremental Direct Medical Costs for Intensive versus Standard Control, According to Four Scenarios for Medication Adherence and Treatment Effect.

Panel A shows incidence rate ratios for the SPRINT primary outcome (the first occurrence of myocardial infarction, acute coronary syndrome not resulting in myocardial infarction, stroke, heart failure, or death from cardiovascular causes) for intensive control versus standard control of systolic blood pressure during the simulation over different time periods. The results are shown according to the four post-trial persistence-of-treatment-effect scenarios: base case (i.e., reduced adherence to the medication regimen and treatment effects after 5 years until total nonadherence and no treatment effects at 15 years), worst case (i.e., nonadherence and no treatment effects after 5 years), best case until 15 years (i.e., in-trial adherence and persistence of treatment effects for 15 years), and lifetime best case (i.e., lifetime in-trial adherence and persistence of treatment effects). Although the assumptions and input were identical for all four scenarios for the first 5 years of the simulation, there were small differences in the incidence rate ratios for cardiovascular disease events for the period from 0 to 5 years that reflect the role of chance in the microsimulation approach. The I bars indicate 95% confidence intervals. Panel B shows the range of mean cumulative incremental direct medical costs of intensive control versus standard control of systolic blood pressure, according to the expenditure — including costs associated with serious adverse events, treatment, background health care for the treatment of noncardiovascular diseases, chronic cardiovascular disease (CVD), or CVD event — in the four post-trial persistence-of-treatment-effect scenarios over time.