[Costs analysis of ambulatory blood pressure monitoring in mild hypertension]

The cost of treating high blood pressure in general practice in France

In this study, the cost of having high blood pressure treated by French general practitioners was estimated, using an analysis of the computerized records for 28,015 patients with either hypertension or history of hypertension over three years. Costs due to visits, drugs, and complementary tests were included. The average annual cost of treatment was 597 euros (SD 377 euros). The annual average cost of drugs was 447 euros, and antihypertensive drugs 258 euros. The average annual cost of patients who were controlled throughout the period was 537 euros, patients who were normalized cost 595 euros, and patients who deteriorated cost 612 euros.

Cost-effectiveness of ambulatory blood pressure monitoring in the follow-up of hypertension

AIMS

To study the cost of the follow-up of hypertension in primary care (PC) using clinical blood pressure (CBP) and ambulatory blood pressure monitoring (ABPM), and to analyse the cost-effectiveness (CE) of both methods.

MAJOR FINDINGS AND PRINCIPAL CONCLUSION

Good control of hypertension was achieved in 8.3% with CBP (95% CI 4.8-11.8) and in 55.6% with ABPM (95% CI 49.3-61.9). The cost of one patient with good control of hypertension is almost four times higher with CBP than with ABPM (Euro 940 vs Euro 238). Reaching the gold standard (ABPM) involved an after-cost of Euro 115 per patient. The results for a 5% discount rate showed a saving of Euro 68,883 if ABPM was performed in all the patients included in the study (n = 241, Euro 285 per patient). An analysis of sensitivity, changing the discount rate and life expectancy indicated that ABPM provides a better CE ratio and a lower global cost. ABPM is more cost-effective than CBP. However, if we include the new treatment cost of poorly monitored patients, it is less cost-effective. Excellent control of hypertension is still an important challenge for all healthcare professionals, especially for those working in PC, where most monitoring of hypertensive patients takes place.

Which is more important for the efficiency of hypertension treatment: hypertension stage, type of drug or therapeutic compliance?

OBJECTIVES

Hypertensive patients are a heterogeneous population that can be distributed in groups showing different cardiovascular risk and benefit from treatment. This study examines the cost-effectiveness of arterial hypertension treatment by age, sex, arterial hypertension stage, type of drug used and level of treatment compliance.

DESIGN

Markov models combining absolute risks for stroke, coronary heart disease and all causes of death with relative risks from clinical trials and observational studies. Data on health costs were collected from hospitals and primary care settings in the Basque Country (Spain).

RESULTS

Cost-effectiveness ratios vary from 34,516 euros/quality adjusted life year (QALY) gained in 30-year-old women to 3,307 euros/QALY in 80-year-old men. A treatment compliance of 50% increases these values to 45,270 and 4,905 euros/QALY, respectively. Treatment of arterial hypertension stage II shows lower ratios (19,798 euros/QALY in 30-year-old women and 1,918 euros/QALY in 80-year-old persons). Cost-effectiveness ratios for arterial hypertension stage I vary from 645 euros/QALY in 80-year-old men for diuretics to 47,325 euros/QALY in 30-year-old women for inhibitors of the angiotensin converting enzyme.

CONCLUSIONS

There are large variations in the cost-effectiveness of arterial hypertension treatment depending on age, sex, arterial hypertension stage, drug used and compliance. Improvement of treatment compliance yields the greatest gain both in effectiveness and efficiency.