Hypertension II
Cost of Hypertension
The economics of health care depends on a progressive decision process that allocates scarce resources, in a manner that achieves the best overall outcomes (Alcocer & Cueto, 2008, p. 147-149). This process is necessarily complicated and imperfect, and the desired result can be influenced by a number of social and political forces, including geographic boundaries, racial and economic disparities, and competing funding needs. To provide the best health care possible for a given funding level, policy makers will need to increasingly rely on evidence-based approaches to help them grasp the cost-effectiveness of specific treatments.
This cost-effectiveness calculation is complicated by conditions or diseases that contribute to the morbidity and mortality of other conditions. For example, hypertension is often recognized as a direct-contributing factor to diabetes, ischemic heart disease, and cerebrovascular disease and aggressive hypertension treatment can’t always be assumed to be cost-effective (Author, 2012). The actual costs realized from aggressively treating hypertension was found to vary in the Western countries studied, from actual cost savings to costing as much as $100,000 dollars per life-years gained (LYG) (Alcocer & Cueto, 2008, p. 153). The variable with the biggest impact on cost-effectiveness was disease risk, with those at high risk gaining the most from treatment.
Such studies beg the question of how much should be spent per LYG? The World Health Organization (WHO) recommends that the cost-effectiveness cutoff for health care interventions should be triple the country’s per capita GDP (Alcocer & Cueto, 2008, p. 153). For the United States this would be U.S.$141,597 per LYG in 2011 (The World Bank, 2012). With a cutoff this high, it seems likely that additional advantages would be obtained by effectively treating the remaining 50% of the U.S. population that does not have its blood pressure under control (reviewed by Trogdon, Allaire, Egan, Lackland, & Masters, 2011).
The Higher the Risk, the Bigger the Benefit
A recent study in Greece examined the cost-effectiveness of treating adults based on their smoking status (Athanasakis, Souliotis, Tountas, Kyriopoulos & Hatzakis, 2011). A total of 1,453 patients completed follow up, of which 47% were male and the overall median age was 59.5 ±9.9 years. Treatment lowered systolic blood pressure an average of 32.0 and 34.7 mmHg for men and women, respectively. The gain in quality adjusted life years were 0.84 and 0.57 per patient for male smokers and nonsmokers, and 0.84 and 0.4 for female smokers and nonsmokers, respectively. Smokers, or high risk patients, were thus more likely to benefit from hypertension treatment.
These results were based how effective treatment was in lowering the relative rates of adverse events. Nonfatal cardiovascular events and death were lowered by 132 and 115 per 1000 patients for male smokers, 112 and 107 for male nonsmokers, 119 and 111 for female smokers, and 91 and 81 for female nonsmokers, respectively. The incremental cost-effectiveness ratios per patient for these patient groups were found to be 3,539, 3,986, 3,957, and 5,485 Euros, respectively. With a WHO intervention cutoff of approximately 60,600 Euros based on Greece’s 2011 gross domestic product (The World Bank, 2012), treating hypertension is easily justified.
Modeling Macroeconomic Cost-Effectiveness
The cost-effectiveness of hypertension treatment not only concerns the benefits realized by individual patients, but economies as a whole (Alcocer & Cueto, 2008). A recent modeling study suggested that a mere 1% reduction in cardiovascular events would save the equivalent of about one U.S. dollar per capita annually in England and Wales (Barton, Andronis, Briggs, McPherson & Capewell, 2011). In the U.S., this would translate into a health care expenditure savings of about $310 million dollars per year. In addition, the modeling study predicted a 5% reduction in hypertension would essentially triple the per capita health care savings realized, or almost a billion dollars annually.
Summary
As health care costs continue to climb, the social and political will to base policy decisions on empirical studies of treatment cost-effectiveness should increase. Based on the studies presented here and elsewhere (Author, 2012), the predicted result of this paradigm shift would be an increase in the overall health of both individuals and the economy as inefficiencies in the system are pruned away.
References
Alcocer, L. & Cueto, L. (2008). Hypertension, a health economics perspective. Therapeutic Advances in Cardiovascular Disease, 2, 147-155. doi: 10.1177/1753944708090572.
Athanasakis, K., Souliotis, K., Tountas, Y., Kyriopoulos, J. & Hatzakis, A. (2011). A cost-utility analysis of hypertension treatment in Greece: Assessing the impact of age, sex and smoking status on outcomes. Journal of Hypertension, 30, 227-234. doi: 10.1097/HJH.0b013e32834d9f18.
Author, J.B. (2012). The cost of hypertension.
Barton, P., Andronis, L., Briggs, A., McPherson, K. & Capewell, S. (2011). Effectiveness and cost effectiveness of cardiovascular disease prevention in whole populations: Modeling study. British Medical Journal, 343, 1-10. doi: 10.1136/bmj.d4044.
The World Bank. (2012). GDP per capita (current U.S.$). Data.WorldBank.org. Retrieved 2 Feb. 2012 from http://data.worldbank.org/indicator/NY.GDP.PCAP.CD.
Trogdon, J.G., Allaire, B.T., Egan, B.M., Lackland, D.T. & Masters, D. (2011). Training providers in hypertension guidelines: Cost-effectiveness evaluation of a continuing medical education program in South Carolina. American Heart Journal, 162, 786-793. doi: 10.1016/j.ahj.2011.06.022.
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