Geisler B, Acharya B, Shrestha A, Pietzsch JB. Long-term clinical and economic outcomes of intensive vs standard blood pressure reduction in non-diabetics at high cardiovascular risk: extrapolations from the SPRINT trial [abstract PHS71]. Poster presentation to the 2017 annual meeting of the International Society for Pharmacoeconomics and Outcomes Research, Boston, 20–24 May 2017. Value Health. 2017;20(5):A359.

Objectives. Results from the recent SPRINT trial demonstrate lower rates of fatal and non-fatal major cardiovascular events and all-cause mortality in non-diabetics at high cardiovascular risk with intensive versus standard treatment (i.e., less than 120 versus less than 140 mmHg systolic, respectively). However, the long-term outcomes remain unknown.

Methods. A validated state transition model with multivariate risk equations was populated with the baseline characteristics of the SPRINT trial, and cost and health-related quality of life data for the United States. Model projections, based on trial-observed blood pressures, were compared to actual median follow-up trial results for calibration. To assess long-term outcomes, we projected 20-year incidence in myocardial infarctions, strokes, heart failure, and end-stage renal disease, and derived relative risks and numbers needed to treat (NNT). Direct medical costs and incremental cost-effectiveness ratio (ICER in $/quality adjusted life year [QALY]), discounted at 3% per annum, were computed for both strategies.

Results. The calibrated model outcomes matched the published SPRINT trial results at a median follow-up of 39 months. Over the 20-year horizon, intense blood pressure control was projected to lead to lower incidences of all studied events; NNTs varied largely between clinical events such as heart failure (696) and cardiovascular and all-cause death (28 and 11, respectively). Life expectancy increased by 2.5 years (85.8 vs. 83.3 years), at similar discounted lifetime costs of about $47K and an ICER of $15,901 per QALY.

Conclusions. Our model-based projections suggest intensive blood pressure control in non-diabetics at high cardiovascular risk is associated with significant long-term benefits. Numbers needed to prevent mortality are particularly attractive. Cost savings seem to be consumed by additional life expectancy. Patient-level data analysis via bootstrapping is necessary to quantify the uncertainty.