(627) Treating Mild Chronic Hypertension during Pregnancy: A Cost-Effectiveness Analysis of the CHAP Trial

Thursday, February 9, 2023

4:00 PM – 5:30 PM

Objective: The CHAP trial, a recently published large randomized controlled trial, found improved outcomes with treating chronic hypertension (cHTN) during pregnancy at a lower threshold than the current standard. However, the cost-effectiveness of this strategy has not been examined.

Study Design: A decision-analytic model was constructed to compare treatment of cHTN once above a systolic blood pressure (SBP) of 140 mmHg and/or diastolic blood pressure (DBP) of 90 mmHg, to treatment of cHTN once above a SBP of 160 mmHg and/or DBP of 110 mmHg in a theoretical cohort of 200,000 patients with mild cHTN. Probabilities, costs, and utilities were derived from literature and varied in sensitivity analysis. Primary outcomes included incremental cost per quality-adjusted life year (QALY), cases of preeclampsia, preeclampsia with severe features, severe maternal morbidity (SMM), preterm birth (PTB), maternal death, neonatal death (NND), and neurodevelopmental delay (NDD). The cost-effectiveness threshold was $100,000/QALY.

Results: Treating cHTN at a lower threshold resulted in 15,752 fewer cases of preeclampsia, 13,149 of which were cases of preeclampsia with severe features. This led to 910 fewer cases of SMM, and 19 fewer cases of maternal death. Treating at a lower threshold also resulted in 8,976 fewer cases of preterm birth, which led to 228 fewer neonatal deaths and 175 fewer cases of neurodevelopmental delay. Overall, treating cHTN at a lower threshold was a dominant strategy resulting in lower costs ($704 million) and increased effectiveness (16,073 QALYs).

Conclusion: Treating cHTN at a reduced threshold is a dominant, cost-effective strategy resulting in fewer neonatal and maternal deaths compared to the standard treatment of treating at higher BP.

Primary & Presenting Author(s)

UD
Uma Doshi, BS (she/her/hers)
Medical Student
Oregon Health and Science University
Portland, Oregon, United States

Coauthor(s)

Sarina R. Chaiken, BA (she/her/hers)
Medical Student
Oregon Health and Science University
Portland, Oregon, United States
Alyssa R. Hersh, MD MPH (she/her/hers)
Resident Physician
Oregon Health and Science University
Portland, Oregon, United States
Aaron B. Caughey, MD,MPH,PhD
Professor and Chair
Oregon Health and Science University
Portland, Oregon, United States