Incremental Expenditure of Treating Hypertension i

Authors: Balu Sanjeev Thomas Joseph

Publish Date: 2006/08/01

Volume: 19, Issue: 8, Pages: 810-816

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Abstract

Analysis of the 2001 Medical Expenditure Panel Survey MEPS a national probability sample survey of the civilian noninstitutionalized US population was conducted Hypertensive patients were identified as those with a medical diagnosis for hypertension based on International Classification of Diseases ICD–9 codes patients who were consumers of hypertensionrelated medical care services including inpatient and outpatient visits emergency room visits home health visits officebased medical provider visits and other medical expenses patients who selfreported being diagnosed with hypertension by their physicians and patients who were prescribed antihypertensive medication Incremental expenditure of treating hypertension was estimated through leastsquares regression adjusting for age sex ethnicity education and comorbidities using the D’Hoore et al version of the Charlson comorbidity index Sample data were projected to the US population and 95 confidence limits for estimates were calculated using the Taylor expansion methodSample estimates projected to the population indicated that approximately 174 of individuals ≥18 years of age in the ambulatory population have hypertension Total incremental annual direct expenditures for hypertension patients were estimated to be more than US 540 billion in 2001 after adjusting for demographics and comorbidities Mean incremental annual direct expenditures for an individual with hypertension was US 1131 Prescription medicines inpatient visits and outpatient visits constituted 90 of overall incremental expendituresHypertension being the most commonly diagnosed disease in the United States1 is an important health problem as the relationship between high blood pressure and risk of cardiovascular cerebrovascular and peripheral vascular diseases is well established2–4 As a modifiable risk factor treatment of hypertension through lifestyle changes and medication is a vital approach to preventing these diseases and has immense public health implications Despite its benefits treatment of hypertension is costly and estimating the cost of hypertension treatment is of significant importance to determine the monetary impact of disease treatment on the societyThe total health care costs of treating hypertension and its complications are estimated to be quite significant ranging from approximately US 150 billion to approximately 600 billion5–10 A study estimating the expenditures attributed to treating hypertensionrelated complications found that cardiovascular complications accounted for approximately US 300 billion and other comorbidities contributed approximately US 570 billion7 These reported expenditures reflect the magnitude of the illness and its epidemiologic public health and economic impact on society thus showing the importance of rational use of resources in health care These estimates were obtained by analyses using the primary diagnosis approach11–13 which included expenditures when hypertension was the primary reported diagnosis or reason for a health care encounter disability or cause of death or considered treatment expenditures related to hypertension using the attributable risk approach1415 popular approaches used in cost of treatment studies but having the potential for not estimating the precise spending related to hypertension Having knowledge of precise disease treatment estimates helps in allocating scarce resources efficiently thereby maximizing the potential for improved clinical and economic outcomes by improving cost savings while maintaining or improving health qualityIncremental cost approach used since the mid1990s16–22 estimates the incremental or excess expenditures of treating a particular disease by comparing the expenditures associated in treating patients diagnosed with the study disease with a group of patients not diagnosed with the study disease Incremental expenditure approach measures expenditures solely attributable to that particular disease as it adjusts for differences in variables deemed to have a bearing on the overall expenditure estimate1116Evaluation of the precise hypertension treatment expenditures can provide important information to guide policies that simultaneously encourage costeffectiveness and improved treatment while maintaining equity Given the clinical importance of hypertension suboptimal state of treatment and magnitude of associated health care costs estimating incremental expenditure of treating hypertension using the incremental expenditure approach by comparing hypertensive patients with nonhypertensive patients is useful to understand effectively both the clinical impact and more precisely the economic impact of hypertension treatment

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