Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Fast track – ISH2022 KYOTO
  • Published:

Economic evaluation of new blood pressure target for hypertensive patients in Taiwan according to the 2022 hypertension clinical practice guidelines of the Taiwan society of cardiology: a simulation modeling study

Hypertension Research volume 46, pages 187–199 (2023)Cite this article

A Comment to this article was published on 05 January 2023

Abstract

With the promising cardiovascular benefits in the STEP and SPRINT trials, the 2022 Taiwan’s hypertension guidelines redefined the hypertension threshold as 130/80 mmHg and a universal blood-pressure target of <130/80 mmHg. This study’s objective was to examine the cost-effectiveness of the intensive blood-pressure target for hypertensive patients using estimated lifetime medical costs and quality-adjusted life years (QALY) from the Taiwan national payer’s perspective. We developed a lifetime Markov model comparing the intensive and conservative blood-pressure targets. Incremental cost-effectiveness ratio (ICER) against the willing-to-pay thresholds at the one-time [US$34,000(NT$1,020,000)] and three-time [US$100,000(NT$3,000,000)] gross domestic product per capita were defined as very cost-effect and only cost-effective. The cost-effectiveness in different age stratifications and cardiovascular risks treated with a more intensive target (120 mmHg) were examined in the subgroup analyses. The new blood-pressure treatment target produced more lifetime medical costs [US$31,589(NT$947,670) versus US$26,788(NT$803,640)] and QALYs (12.54 versus 12.25), and the ICER was US$16,589(NT$497,670), which was 99.1% and 100% probability of a very cost-effective and cost-effective strategy. The ICERs in all age stratifications had more than a 90% probability of being very cost-effective, and ICERs decreased with age. More intensive control in patients with high cardiovascular risks produced a lower ICER [US$14,547(NT$436,410)]. In conclusion, Taiwan’s new blood-pressure treatment target can prevent more cardiovascular events with acceptable costs per QALY below the willing-to-pay thresholds. The cost-effectiveness of intensive control is consistent across different ages and more pronounced with the increase in age and cardiovascular risk.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014;11:507–20.

    Article  Google Scholar 

  2. Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, et al. 2018 ESC/ESH guidelines for the management of arterial hypertension. Eur Heart J. 2018;39:3021–104.

    Article  Google Scholar 

  3. 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. Circulation. 2018;138:e426–83.

    Google Scholar 

  4. Ettehad D, Emdin CA, Kiran A, Anderson SG, Callender T, Emberson J, et al. Blood pressure lowering for prevention of cardiovascular disease and death: a systematic review and meta-analysis. Lancet. 2016;387:957–67.

    Article  Google Scholar 

  5. SPRINT Research Group, Wright JT Jr, Williamson JD, Whelton PK, Snyder JK, Sink KM, et al. A randomized trial of intensive versus standard blood-pressure control. N. Engl J Med. 2015;373:2103–16.

    Article  Google Scholar 

  6. Douros A, Tölle M, Ebert N, Gaedeke J, Huscher D, Kreutz R, et al. Control of blood pressure and risk of mortality in a cohort of older adults: the Berlin Initiative Study. Eur Heart J. 2019;40:2021–8.

    Article  CAS  Google Scholar 

  7. Zhang W, Zhang S, Deng Y, Wu S, Ren J, Sun G, et al. Trial of intensive blood-pressure control in older patients with hypertension. N. Engl J Med. 2021;385:1268–79.

    Article  CAS  Google Scholar 

  8. Wang TD, Chiang CE, Chao TH, Cheng HM, Wu YW, Wu YJ, et al. 2022 Guidelines of the Taiwan society of cardiology and the Taiwan hypertension society for the management of hypertension. Acta Cardiol Sin. 2022;38:225–325.

    Google Scholar 

  9. Bress AP, Bellows BK, King JB, Hess R, Beddhu S, Zhang Z, et al. Cost-effectiveness of intensive versus standard blood-pressure control. N. Engl J Med. 2017;377:745–55.

    Article  Google Scholar 

  10. Richman IB, Fairley M, Jørgensen ME, Schuler A, Owens DK, Goldhaber-Fiebert JD. Cost-effectiveness of intensive blood pressure management. JAMA Cardiol. 2016;1:872–9.

    Article  Google Scholar 

  11. Health Technology Assessment of Center for Drug Evaluation, Taiwan. Taiwan guidelines of methodological standards for pharmacoeconomic evaluation. Accessed on May 3, 2022 from https://www.cde.org.tw/HTA/history.

  12. SCORE2 working group and ESC Cardiovascular risk collaboration. SCORE2 risk prediction algorithms: new models to estimate 10-year risk of cardiovascular disease in Europe. Eur Heart J. 2021;42:2439–54.

  13. SCORE2-OP working group and ESC Cardiovascular risk collaboration, SCORE2-OP risk prediction algorithms: estimating incident cardiovascular event risk in older persons in four geographical risk regions. Eur Heart J. 2021;42:2455–67

  14. Goff DC Jr, Lloyd-Jones DM, Bennett G, Coady S, D’Agostino RB, Gibbons R, et al. American College of Cardiology/American Heart Association Task Force on Practice Guidelines. 2013 ACC/AHA guideline on the assessment of cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;129:S49–73.

    Article  Google Scholar 

  15. Chien KL, Hsu HC, Su TC, Chang WT, Chen PC, Sung FC, et al. Constructing a point-based prediction model for the risk of coronary artery disease in a Chinese community: a report from a cohort study in Taiwan. Int J Cardiol. 2012;157:263–8.

    Article  Google Scholar 

  16. Ministry of the Interior. Republic of China (Taiwan), Life Tables. Accessed on April 3, 2022. https://www.moi.gov.tw/english/cl.aspx?n=7779.

  17. Burnier M, Egan BM. Adherence in hypertension. Circ Res. 2019;124:1124–40.

    Article  CAS  Google Scholar 

  18. Iskedjian M, Einarson TR, MacKeigan LD, Shear N, Addis A, Mittmann N, et al. Relationship between daily dose frequency and adherence to antihypertensive pharmacotherapy: evidence from a meta-analysis. Clin Ther. 2002;24:302–16.

    Article  Google Scholar 

  19. Bank of Taiwan. Accessed on June 1, 2022. https://rate.bot.com.tw/xrt?Lang=zh-TW.

  20. International Monetary Fund. World Economic Outlook Database, April 2022. Accessed on 19 May 2022. https://www.imf.org/en/Home.

  21. Bertram MY, Lauer JA, De Joncheere K, Edejer T, Hutubessy R, Kieny MP, et al. Cost–effectiveness thresholds: pros and cons. Bull World Health Organ. 2016;94:925.

    Article  Google Scholar 

  22. Briggs AH. Handling uncertainty in cost-effectiveness models. Pharmacoeconomics. 2000;17:479–500.

    Article  CAS  Google Scholar 

  23. Taiwan Ministry of Health and Welfare. Cause of Death Statistics. https://www.mohw.gov.tw/np-128-2.html. Accessed 30 May 2019.

  24. Chia YC, Buranakitjaroen P, Chen CH, Divinagracia R, Hoshide S, Park S, et al. Current status of home blood pressure monitoring in Asia: Statement from the HOPE Asia Network. J Clin Hypertens (Greenwich). 2017;19:1192–201.

    Article  Google Scholar 

  25. Cheng HM, Lin HJ, Wang TD, Chen CH. Asian management of hypertension: Current status, home blood pressure, and specific concerns in Taiwan. J Clin Hypertens (Greenwich). 2020;22:511–4.

    Article  Google Scholar 

  26. Taiwan Health Promotion Administration MoHaW. National Health Interview Survey. https://www.hpa.gov.tw/. Accessed on June, 2022.

  27. Liao CT, Yang CT, Kuo FH, Lee MC, Chang WT, Tang HJ, et al. Cost-effectiveness evaluation of add-on empagliflozin in patients with heart failure and a reduced ejection fraction from the healthcare system’s perspective in the Asia-Pacific region. Front Cardiovasc Med. 2021;8:750381.

    Article  CAS  Google Scholar 

  28. Liao CT, Yang CT, Toh HS, Chang WT, Chang HY, Kuo FH, et al. Cost-effectiveness evaluation of add-on dapagliflozin for heart failure with reduced ejection fraction from perspective of healthcare systems in Asia-Pacific region. Cardiovasc Diabetol. 2021;20:204.

    Article  CAS  Google Scholar 

  29. Lee MC, Liao CT, Toh HS, Chou CC, Chang WT, Chen ZC, et al. Cost-effectiveness analysis of rivaroxaban plus aspirin versus aspirin alone in secondary prevention among patients with chronic cardiovascular diseases. Cardiovasc Drugs Ther. 2021;35:539–47.

    Article  CAS  Google Scholar 

  30. Liao CT, Lee MC, Chen ZC, Ku LE, Wang JD, Toh HS. Cost-effectiveness analysis of oral anticoagulants in stroke prevention among patients with atrial fibrillation in Taiwan. Acta Cardiol Sin. 2020;36:50–61.

    Google Scholar 

  31. Li C, Chen K, Cornelius V, Tomeny E, Wang Y, Yang X, et al. Applicability and cost-effectiveness of the Systolic Blood Pressure Intervention Trial (SPRINT) in the Chinese population: A cost-effectiveness modeling study. PLoS Med. 2021;18:e1003515.

    Article  Google Scholar 

  32. Lin SF, Kuo TT, Pan WH, Bai CH. Effects of socioeconomic status on the control of hypertension in patients <65 and ≥65 years of age in Taiwan: a nationwide cross-sectional study. BMJ Open. 2022;12:e050041.

    Article  Google Scholar 

Download references

Acknowledgements

CTL drafted the manuscript. CTL, HST, CTY and CYH contributed to this study, including the conception and design of the research. CTL, WTC and HYC contributed to this study’s data extraction, analyses, and interpretation of data. This manuscript was revised by HST, WTC, ZCC, and CS. All authors gave final approval and agree to all aspects of the work, ensuring integrity and accuracy. We appreciated the supports of Professor Zhen-Yu Zhang, Dongmei Wei and Jesus Melgarejo from KU Leuven.

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: this project was supported by a grant to Chia-Te Liao from the Ministry of Science and Technology in Taiwan (MOST 111–2917-I-006–007 and MOST 111–2314-B-384-003), and Chi Mei Medical Center (CMHCR11003).

Author information

Authors and Affiliations

  1. Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan

    Chia-Te Liao, Mei-Chuan Lee & Carol Strong

  2. Division of Cardiology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan

    Chia-Te Liao, Wei-Ting Chang & Zhih-Cherng Chen

  3. Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium

    Chia-Te Liao

  4. Department of Intensive Care Medicine, Chi Mei Medical Center, Tainan, Taiwan

    Han Siong Toh & Wei-Ting Chang

  5. Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan

    Han Siong Toh

  6. Department of Health and Nutrition, Chia Nan University of Pharmacy & Science, Tainan, Taiwan

    Han Siong Toh & Wei-Ting Chang

  7. Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan

    Chun-Ting Yang

  8. Division of Cardiology and Cardiovascular Research Center, Department of Internal Medicine, Taipei Medical University, Taipei, Taiwan

    Chien-Yi Hsu

  9. Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan

    Chien-Yi Hsu

  10. Taipei Heart Institute, Taipei Medical University, Taipei, Taiwan

    Chien-Yi Hsu

  11. Department of Pharmacy, Chi-Mei Medical Centre, Tainan, Taiwan

    Mei-Chuan Lee

  12. Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan

    Hung-Yu Chang

  13. Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan

    Hung-Yu Chang

Authors
  1. Chia-Te Liao
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Han Siong Toh
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Chun-Ting Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Chien-Yi Hsu
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Mei-Chuan Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Wei-Ting Chang
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Zhih-Cherng Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Hung-Yu Chang
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Carol Strong
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding authors

Correspondence to Chia-Te Liao or Han Siong Toh.

Ethics declarations

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Liao, CT., Toh, H.S., Yang, CT. et al. Economic evaluation of new blood pressure target for hypertensive patients in Taiwan according to the 2022 hypertension clinical practice guidelines of the Taiwan society of cardiology: a simulation modeling study. Hypertens Res 46, 187–199 (2023). https://doi.org/10.1038/s41440-022-01037-5

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41440-022-01037-5

Keyword

This article is cited by

Search

Advanced search

Quick links