The Cost Implications of Less Tight Versus Tight Control of Hypertension in Pregnancy (CHIPS Trial)

Rashid J. Ahmed; Amiram Gafni; Eileen K. Hutton; Zheng Jing Hu; Eleanor Pullenayegum; Peter von Dadelszen; Evelyne Rey; Susan Ross; Elizabeth Asztalos; Kellie E. Murphy; Jennifer Menzies; J. Johanna Sanchez; Wessel Ganzevoort; Michael Helewa; Shoo K. Lee; Terry Lee; Alexander G. Logan; Jean-Marie Moutquin; Joel Singer; Jim G. Thornton; Ross Welch; Laura A. Magee

doi:10.1161/HYPERTENSIONAHA.116.07466

The Cost Implications of Less Tight Versus Tight Control of Hypertension in Pregnancy (CHIPS Trial)

Rashid J. Ahmed, Amiram Gafni, Eileen K. Hutton, Zheng Jing Hu, Eleanor Pullenayegum, Peter von Dadelszen, Evelyne Rey, Susan Ross, Elizabeth Asztalos, Kellie E. Murphy, Jennifer Menzies, J. Johanna Sanchez, Wessel Ganzevoort, Michael Helewa, Shoo K. Lee, Terry Lee, Alexander G. Logan, Jean-Marie Moutquin, Joel Singer, Jim G. ThorntonRoss Welch, Laura A. Magee

Women & Children's Health

Research output: Contribution to journal › Article › peer-review

11 Citations (Scopus)

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Abstract

The CHIPS randomized controlled trial (Control of Hypertension in Pregnancy Study) found no difference in the primary perinatal or secondary maternal outcomes between planned textquotedblleftless tighttextquotedblright (target diastolic 100 mm Hg) and textquotedbllefttighttextquotedblright (target diastolic 85 mm Hg) blood pressure management strategies among women with chronic or gestational hypertension. This study examined which of these management strategies is more or less costly from a third-party payer perspective. A total of 981 women with singleton pregnancies and nonsevere, nonproteinuric chronic or gestational hypertension were randomized at 14 to 33 weeks to less tight or tight control. Resources used were collected from 94 centers in 15 countries and costed as if the trial took place in each of 3 Canadian provinces as a cost-sensitivity analysis. Eleven hospital ward and 24 health service costs were obtained from a similar trial and provincial government health insurance schedules of medical benefits. The mean total cost per womantextendashinfant dyad was higher in less tight versus tight control, but the difference in mean total cost (DM) was not statistically significant in any province: Ontario ($30 191.62 versus $24 469.06; DM $5723, 95% confidence interval, -$296 to $12 272; P=0.0725); British Columbia ($30 593.69 versus $24 776.51; DM $5817; 95% confidence interval, -$385 to $12 349; P=0.0725); or Alberta ($31 510.72 versus $25 510.49; DM $6000.23; 95% confidence interval, -$154 to $12 781; P=0.0637). Tight control may benefit women without increasing risk to neonates (as shown in the main CHIPS trial), without additional (and possibly lower) cost to the healthcare system.Clinical Trial RegistrationtextemdashURL: http://www.clinicaltrials.gov. Unique identifier: NCT01192412.Novelty and Significance

Original language	English
Pages (from-to)	1049-1055
Number of pages	7
Journal	Hypertension
Volume	68
Issue number	4
Early online date	22 Aug 2016
DOIs	https://doi.org/10.1161/HYPERTENSIONAHA.116.07466
Publication status	E-pub ahead of print - 22 Aug 2016

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© 2016 The Authors. Hypertension is published on behalf of the American Heart Association, Inc., by Wolters Kluwer. This is an open access article under the terms of the Creative Commons Attribution Non-Commercial-NoDervis License, which permits use, distribution, and reproduction in any medium, provided that the original work is properly cited, the use is noncommercial, and no modifications or adaptations are made.
Final published version, 1.63 MBLicence: CC BY-NC-ND

http://hyper.ahajournals.org/content/68/4/1049

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Ahmed, R. J., Gafni, A., Hutton, E. K., Hu, Z. J., Pullenayegum, E., von Dadelszen, P., Rey, E., Ross, S., Asztalos, E., Murphy, K. E., Menzies, J., Sanchez, J. J., Ganzevoort, W., Helewa, M., Lee, S. K., Lee, T., Logan, A. G., Moutquin, J.-M., Singer, J., ... Magee, L. A. (2016). The Cost Implications of Less Tight Versus Tight Control of Hypertension in Pregnancy (CHIPS Trial). Hypertension, 68(4), 1049-1055. Advance online publication. https://doi.org/10.1161/HYPERTENSIONAHA.116.07466

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title = "The Cost Implications of Less Tight Versus Tight Control of Hypertension in Pregnancy (CHIPS Trial)",

abstract = "The CHIPS randomized controlled trial (Control of Hypertension in Pregnancy Study) found no difference in the primary perinatal or secondary maternal outcomes between planned textquotedblleftless tighttextquotedblright (target diastolic 100 mm Hg) and textquotedbllefttighttextquotedblright (target diastolic 85 mm Hg) blood pressure management strategies among women with chronic or gestational hypertension. This study examined which of these management strategies is more or less costly from a third-party payer perspective. A total of 981 women with singleton pregnancies and nonsevere, nonproteinuric chronic or gestational hypertension were randomized at 14 to 33 weeks to less tight or tight control. Resources used were collected from 94 centers in 15 countries and costed as if the trial took place in each of 3 Canadian provinces as a cost-sensitivity analysis. Eleven hospital ward and 24 health service costs were obtained from a similar trial and provincial government health insurance schedules of medical benefits. The mean total cost per womantextendashinfant dyad was higher in less tight versus tight control, but the difference in mean total cost (DM) was not statistically significant in any province: Ontario ($30 191.62 versus $24 469.06; DM $5723, 95% confidence interval, -$296 to $12 272; P=0.0725); British Columbia ($30 593.69 versus $24 776.51; DM $5817; 95% confidence interval, -$385 to $12 349; P=0.0725); or Alberta ($31 510.72 versus $25 510.49; DM $6000.23; 95% confidence interval, -$154 to $12 781; P=0.0637). Tight control may benefit women without increasing risk to neonates (as shown in the main CHIPS trial), without additional (and possibly lower) cost to the healthcare system.Clinical Trial RegistrationtextemdashURL: http://www.clinicaltrials.gov. Unique identifier: NCT01192412.Novelty and Significance",

author = "Ahmed, {Rashid J.} and Amiram Gafni and Hutton, {Eileen K.} and Hu, {Zheng Jing} and Eleanor Pullenayegum and {von Dadelszen}, Peter and Evelyne Rey and Susan Ross and Elizabeth Asztalos and Murphy, {Kellie E.} and Jennifer Menzies and Sanchez, {J. Johanna} and Wessel Ganzevoort and Michael Helewa and Lee, {Shoo K.} and Terry Lee and Logan, {Alexander G.} and Jean-Marie Moutquin and Joel Singer and Thornton, {Jim G.} and Ross Welch and Magee, {Laura A.}",

year = "2016",

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doi = "10.1161/HYPERTENSIONAHA.116.07466",

language = "English",

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pages = "1049--1055",

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publisher = "American Heart Association, Inc.",

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Ahmed, RJ, Gafni, A, Hutton, EK, Hu, ZJ, Pullenayegum, E, von Dadelszen, P, Rey, E, Ross, S, Asztalos, E, Murphy, KE, Menzies, J, Sanchez, JJ, Ganzevoort, W, Helewa, M, Lee, SK, Lee, T, Logan, AG, Moutquin, J-M, Singer, J, Thornton, JG, Welch, R & Magee, LA 2016, 'The Cost Implications of Less Tight Versus Tight Control of Hypertension in Pregnancy (CHIPS Trial)', Hypertension, vol. 68, no. 4, pp. 1049-1055. https://doi.org/10.1161/HYPERTENSIONAHA.116.07466

TY - JOUR

T1 - The Cost Implications of Less Tight Versus Tight Control of Hypertension in Pregnancy (CHIPS Trial)

AU - Ahmed, Rashid J.

AU - Gafni, Amiram

AU - Hutton, Eileen K.

AU - Hu, Zheng Jing

AU - Pullenayegum, Eleanor

AU - von Dadelszen, Peter

AU - Rey, Evelyne

AU - Ross, Susan

AU - Asztalos, Elizabeth

AU - Murphy, Kellie E.

AU - Menzies, Jennifer

AU - Sanchez, J. Johanna

AU - Ganzevoort, Wessel

AU - Helewa, Michael

AU - Lee, Shoo K.

AU - Lee, Terry

AU - Logan, Alexander G.

AU - Moutquin, Jean-Marie

AU - Singer, Joel

AU - Thornton, Jim G.

AU - Welch, Ross

AU - Magee, Laura A.

PY - 2016/8/22

Y1 - 2016/8/22

N2 - The CHIPS randomized controlled trial (Control of Hypertension in Pregnancy Study) found no difference in the primary perinatal or secondary maternal outcomes between planned textquotedblleftless tighttextquotedblright (target diastolic 100 mm Hg) and textquotedbllefttighttextquotedblright (target diastolic 85 mm Hg) blood pressure management strategies among women with chronic or gestational hypertension. This study examined which of these management strategies is more or less costly from a third-party payer perspective. A total of 981 women with singleton pregnancies and nonsevere, nonproteinuric chronic or gestational hypertension were randomized at 14 to 33 weeks to less tight or tight control. Resources used were collected from 94 centers in 15 countries and costed as if the trial took place in each of 3 Canadian provinces as a cost-sensitivity analysis. Eleven hospital ward and 24 health service costs were obtained from a similar trial and provincial government health insurance schedules of medical benefits. The mean total cost per womantextendashinfant dyad was higher in less tight versus tight control, but the difference in mean total cost (DM) was not statistically significant in any province: Ontario ($30 191.62 versus $24 469.06; DM $5723, 95% confidence interval, -$296 to $12 272; P=0.0725); British Columbia ($30 593.69 versus $24 776.51; DM $5817; 95% confidence interval, -$385 to $12 349; P=0.0725); or Alberta ($31 510.72 versus $25 510.49; DM $6000.23; 95% confidence interval, -$154 to $12 781; P=0.0637). Tight control may benefit women without increasing risk to neonates (as shown in the main CHIPS trial), without additional (and possibly lower) cost to the healthcare system.Clinical Trial RegistrationtextemdashURL: http://www.clinicaltrials.gov. Unique identifier: NCT01192412.Novelty and Significance

AB - The CHIPS randomized controlled trial (Control of Hypertension in Pregnancy Study) found no difference in the primary perinatal or secondary maternal outcomes between planned textquotedblleftless tighttextquotedblright (target diastolic 100 mm Hg) and textquotedbllefttighttextquotedblright (target diastolic 85 mm Hg) blood pressure management strategies among women with chronic or gestational hypertension. This study examined which of these management strategies is more or less costly from a third-party payer perspective. A total of 981 women with singleton pregnancies and nonsevere, nonproteinuric chronic or gestational hypertension were randomized at 14 to 33 weeks to less tight or tight control. Resources used were collected from 94 centers in 15 countries and costed as if the trial took place in each of 3 Canadian provinces as a cost-sensitivity analysis. Eleven hospital ward and 24 health service costs were obtained from a similar trial and provincial government health insurance schedules of medical benefits. The mean total cost per womantextendashinfant dyad was higher in less tight versus tight control, but the difference in mean total cost (DM) was not statistically significant in any province: Ontario ($30 191.62 versus $24 469.06; DM $5723, 95% confidence interval, -$296 to $12 272; P=0.0725); British Columbia ($30 593.69 versus $24 776.51; DM $5817; 95% confidence interval, -$385 to $12 349; P=0.0725); or Alberta ($31 510.72 versus $25 510.49; DM $6000.23; 95% confidence interval, -$154 to $12 781; P=0.0637). Tight control may benefit women without increasing risk to neonates (as shown in the main CHIPS trial), without additional (and possibly lower) cost to the healthcare system.Clinical Trial RegistrationtextemdashURL: http://www.clinicaltrials.gov. Unique identifier: NCT01192412.Novelty and Significance

U2 - 10.1161/HYPERTENSIONAHA.116.07466

DO - 10.1161/HYPERTENSIONAHA.116.07466

M3 - Article

SN - 0194-911X

VL - 68

SP - 1049

EP - 1055

JO - Hypertension

JF - Hypertension

IS - 4

ER -

The Cost Implications of Less Tight Versus Tight Control of Hypertension in Pregnancy (CHIPS Trial)

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