Cost-Effectiveness of Antihypertensive Deprescribing in Primary Care: a Markov Modelling Study Using Data From the OPTiMISE Trial

Background: Deprescribing of antihypertensive medications for older patients with normal blood pressure is recommended by some clinical guidelines, where the potential harms of treatment may outweigh the benefits. This study aimed to assess the cost-effectiveness of this approach. Methods: A Markov patient-level simulation was undertaken to model the effect of withdrawing one antihypertensive compared with usual care, over a life-time horizon. Model population characteristics were estimated using data from the OPTiMISE antihypertensive deprescribing trial, and the effects of blood pressure changes on outcomes were derived from the literature. Health-related quality of life was modeled in Quality-Adjusted Life Years (QALYs) and presented as costs per QALY gained. Results: In the base-case analysis, medication reduction resulted in lower costs than usual care (mean difference 185) pound, but also lower QALYs (mean difference 0.062) per patient over a life-time horizon. Usual care was cost-effective at 2975 pound per QALY gained (more costly, but more effective). Medication reduction resulted more heart failure and stroke/TIA events but fewer adverse events. Medication reduction may be the preferred strategy at a willingness-to-pay of 20 pound 000/QALY, where the baseline absolute risk of serious drug-related adverse events was >= 7.7% a year (compared with 1.7% in the base-case). Conclusions: Although there was uncertainty around many of the assumptions underpinning this model, these findings suggest that antihypertensive medication reduction should not be attempted in many older patients with controlled systolic blood pressure. For populations at high risk of adverse effects, deprescribing may be beneficial, but a targeted approach would be required in routine practice.

Automated summary

This study assessed the cost-effectiveness of deprescribing antihypertensive medications for older patients with normal blood pressure. The findings suggest that reducing medication use is not advisable for many older patients with controlled systolic blood pressure, but may be beneficial for high-risk populations with targeted approaches.