Presentation (CTI)

OBJECTIVES: Over two-thirds of type 2 diabetes patients have hypertension and a recent clinical trial (BPROAD) demonstrated that intensive therapy (systolic BP < 120 mmHg) is more effective than standard therapy (systolic BP < 140 mmHg) in reducing the risk of cardiovascular events among high-risk hypertensive diabetic patients. This study aims to assess the cost-effectiveness of intensive vs standard therapy among hypertensive type 2 diabetic patients using a U.S. healthcare payer perspective.
METHODS: A Markov model, informed by health states from BPROAD, was constructed and analyzed using TreeAge Pro 2025. The model simulates a lifetime horizon with monthly cycles to estimate total costs, quality-adjusted life years (QALYs), and the incremental cost-effectiveness ratio (ICER). This model included event-free hypertension and type 2 Diabetes, myocardial infarction (MI), stroke, heart failure (HF), and death states. Transition probabilities, costs, and utility values were derived from published clinical trials, U.S.-based literature, and costs were inflated to 2025 dollars. The model was calibrated to align with the trial’s primary outcome, a composite of MI, stroke, HF, and cardiovascular death, across both treatment arms. Acute and chronic costs of cardiovascular events were incorporated. One-way sensitivity and probabilistic sensitivity analysis (PSA) using second-order Monte Carlo simulation (10,000 iterations) was conducted to assess parameter uncertainty.
RESULTS: Standard treatment yielded 10.44 QALYs and accrued $366,311 in lifetime costs, while intensive treatment yielded 11.26 QALYs and accrued $402,460, yielding an incremental cost-effectiveness ratio of $43,662/QALY. None of the 1-way sensitivity analyses yielded an ICER > $100,000/QALY, and the PSA showed that intensive management was cost-effective in 91.5% of iterations at a willingness to pay threshold of $100,000.
CONCLUSIONS: Intensively managing hypertension of type 2 diabetics is expected to generate an additional 9.8 months of quality-adjusted survival and would be considered a cost-effective strategy at commonly accepted willingness to pay thresholds.