Cost-effectiveness analysis of early antihypertensive treatment for hypertension detected at health screening.

BACKGROUND

Delayed initiation of antihypertensive therapy after the initial identification of hypertension during health checkups has been linked to an increased risk of cardiovascular disease. However, the long-term economic implications of this practice are not well understood. This study aimed to analyze the cost-effectiveness of early antihypertensive treatment.

METHODS

A Markov cohort model with four health states (baseline hypertension, acute cardiovascular disease (CVD), post-CVD, and death) was developed to project long-term outcomes for adults with screening-detected hypertension using data from the Japan Medical Data Center database, recorded January 2005-April 2021. Age-specific transition probabilities, CVD-related costs, and mortality were derived from a previously published cohort. Quality-adjusted life-years (QALYs) were estimated using utility values from prior literature. Early (<1 year) versus delayed (≥1 year) treatment initiation were compared across four age groups over a 20-year horizon from the healthcare payer perspective, applying a 2% annual discount rate. Deterministic and probabilistic sensitivity analyses assessed parameter uncertainty, and cost-effectiveness was evaluated against a willingness-to-pay threshold of ¥5 million per QALY.

RESULTS

In adults in their 40 s, early initiation yielded 13.52 QALYs and lifetime costs of ¥3,991,757, compared with 12.85 QALYs and ¥3,976,709 with delayed initiation, resulting in an incremental cost-effectiveness ratio of ¥22,489 per QALY. Early initiation remained highly cost-effective across all age groups, and probabilistic analyses demonstrated a high likelihood of cost-effectiveness.

CONCLUSIONS

These findings support encouraging healthcare payers to use screening results proactively to promote early hypertension management and strengthen follow-up systems that reduce delays between detection and appropriate treatment.