Toward targeted hypertension screening guidelines

Toward targeted hypertension screening guidelines

van Buuren, S.
Boshuizen, H.C.
Reijneveld, S.A.
TNO Kwaliteit van Leven

2006

Background. Guidelines for screening and subsequent treatment of hypertension vary widely between countries. Part of this variation can be attributed to systematic differences between populations, but little is known about the way in which guidelines should be targeted to the population of interest. Optimal guidelines should have high yield and low complexity. The goal is to fit procedures for screening and subsequent treatment of hypertension optimally to a specific population. Methods. Simulation study on individual cardiovascular risk profiles, with drug treatment altering the 10-year cardiovascular risk. The analysis compares the consequences of various screening and treatment alternatives. The reference scenario consists of the Dutch hypertension guidelines for primary care. A representative sample of the Dutch population aged 20 years and older is taken as the target. Main outcome measures include incidence, quality-adjusted life years won, number needed to screen, and costs (prevention, morbidity, and mortality). The discount rate is 4%. Results. Strict adherence to the current hypertension guidelines saves costs (i.e., the total prevention costs are less than the costs of prevented morbidity and mortality). The following changes increase its cost-effectiveness: use of lower blood pressure levels for screening and treatment, reduction of the number of screens from 5 to 3, and active call-up of high-risk patients. The adherence to guidelines has a large influence on actual cost-effectiveness achieved in practice. Conclusions. Appropriate targeting of hypertension guidelines to a population and critical appraisal of the entire screening procedure can enhance cost-effectiveness.

Health
Cardiovascular risk
Cost effectiveness analysis
Evidence based medicine
Female
Health care cost
High risk patient
High risk population
Incidence
Major clinical study
Male
Population research
Practice guideline
Primary medical care
Quality adjusted life year
Adult
Aged
Cost-Benefit Analysis
Guideline Adherence
Health Care Costs
Humans
Hypertension
Mass Screening
Middle Aged
Models, Theoretical
Netherlands
Practice Guidelines
Primary Health Care
Quality-Adjusted Life Years
Risk Factors
Risk Reduction Behavior

http://resolver.tudelft.nl/uuid:c67494f8-ec9a-4cef-8738-5ad51cf56cd2

https://doi.org/10.1177/0272989x06286479

239171

0272-989X

Medical Decision Making, 26 (2), 145-153

article