Subject(s)
American Heart Association/organization & administration , Aortic Diseases , Biomedical Research/organization & administration , Peripheral Arterial Disease , Research Personnel/organization & administration , Advisory Committees/organization & administration , American Heart Association/economics , Animals , Aortic Diseases/diagnosis , Aortic Diseases/mortality , Aortic Diseases/physiopathology , Aortic Diseases/therapy , Biomedical Research/economics , Humans , Peripheral Arterial Disease/diagnosis , Peripheral Arterial Disease/mortality , Peripheral Arterial Disease/physiopathology , Peripheral Arterial Disease/therapy , Research Personnel/economics , Research Support as Topic/organization & administration , United StatesABSTRACT
The 2017 guidelines on the diagnosis and treatment of high blood pressure in adults were published by the American College of Cardiology and the American Heart Association. The impact on clinical outcomes and costs needs to be estimated prior to adopting these guidelines in China. Data from a nationally representative sample in China were analyzed. The prevalence and treatment were calculated based on the criteria of the 2017 guidelines and 2018 Chinese guidelines among participants aged ≥35 years old. Direct medical costs, as well as the averted disability adjusted of life years and cost saving from cardiovascular disease events prevented by controlling hypertension, were also estimated. The prevalence and treatment rate of hypertension were 32.0% and 43.4% according to the 2018 Chinese guidelines. Based on the 2017 guidelines, another 24.5% of the adult population (estimated 168.1 million) would be classified as having hypertension; of whom, about 32.1 million would need to be pharmaceutically treated to reach the current treatment rate of 43.4%. As a result, an estimated additional 42.7 billion US dollars of the direct medical cost would be required for lifetime therapy. By preventing cardiovascular events, the new guidelines would reduce lifetime costs by 3.77 billion US dollars, while preventing 1.41 million disability adjusted of life years lost. Application of the 2017 guidelines in China will substantially increase the prevalence of hypertension and produce a large increase in therapy costs, although it would prevent cardiovascular disease events and save disability adjusted of life years.
Subject(s)
American Heart Association/economics , Cardiology/economics , Guidelines as Topic/standards , Hypertension/diagnosis , Outcome Assessment, Health Care/economics , Adult , Aged , Aged, 80 and over , American Heart Association/organization & administration , Antihypertensive Agents/economics , Antihypertensive Agents/therapeutic use , Cardiology/organization & administration , Cardiovascular Diseases/economics , Cardiovascular Diseases/prevention & control , China/epidemiology , Cost of Illness , Disability Evaluation , Female , Humans , Hypertension/classification , Hypertension/drug therapy , Hypertension/epidemiology , Male , Middle Aged , Outcome Assessment, Health Care/statistics & numerical data , Prevalence , Quality-Adjusted Life Years , United States/epidemiologySubject(s)
Academies and Institutes , American Heart Association , Cardiovascular Diseases/therapy , Comparative Effectiveness Research , Precision Medicine , Academies and Institutes/economics , American Heart Association/economics , Cardiovascular Diseases/diagnosis , Cardiovascular Diseases/genetics , Cardiovascular Diseases/mortality , Clinical Decision-Making , Comparative Effectiveness Research/economics , Crowdsourcing , Genetic Predisposition to Disease , Humans , Phenotype , Precision Medicine/economics , Predictive Value of Tests , Prognosis , Research Support as Topic , United StatesSubject(s)
Advisory Committees/standards , American Heart Association , Cardiology/standards , Practice Guidelines as Topic/standards , Research Report/standards , Advisory Committees/economics , American Heart Association/economics , Cardiology/economics , Cardiology/methods , Cost-Benefit Analysis , Humans , United StatesABSTRACT
The recent American College of Cardiology/American Heart Association guideline recommended carotid artery stenting (CAS) as an alternative to carotid endarterectomy (CEA) for symptomatic patients. This and the Carotid Revascularization Endarterectomy versus Stenting Trial (CREST) form the basis for seeking more liberalized indications and reimbursement for CAS. For the years 2005-2007, >130,000 carotid interventions/year were performed, 88.6% of which were CEAs and 11.4% were CAS. For the same years, each CAS procedure had on average $12,000-$13,500 more expensive mean total hospital charges than each CEA. If the percentages of CAS and CEA had been equal (ie, 50% CAS and 50% CEA), this would translate into an additional $2,000,000,000 in charges for these 3 years. It seems unreasonable to approve enhanced reimbursement for CAS at this time, especially since the large incremental costs would go to support CAS procedures that are inferior in most symptomatic patients and possibly unnecessary in most asymptomatic patients.