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Assessment of the association between blood pressure control and health care resource use
P Lapuerta1, T Simon, A Smitten
1Bristol-Myers Squibb Pharmaceutical Research Institute, Princeton, New Jersey 08543-4000, USA. lapuertp@bms.com
Insights
Uncontrolled high blood pressure (BP) leads to more frequent doctor visits, increasing healthcare costs. Managing hypertension effectively reduces patient visits and associated expenses.
Area of Science:
- Cardiology
- Health Economics
- Public Health
Background:
- Hypertension is linked to increased healthcare resource utilization.
- Previous studies indicate higher costs for patients with uncontrolled blood pressure (BP).
Purpose of the Study:
- To examine the association between blood pressure (BP) control and healthcare resource use.
- To determine the impact of BP management on patient visit frequency and associated costs.
Main Methods:
- Analysis of data from the Caring for Hypertension on Initiation: Costs and Effectiveness (CHOICE) study.
- Randomized controlled trial comparing two antihypertensive medication groups.
- Cox regression modeling to assess time to next physician visit based on BP control.
Main Results:
- Patients with uncontrolled BP (> or = 140/90 mm Hg) had significantly shorter time to next visit.
- Higher systolic and diastolic BP measurements correlated with earlier follow-up visits.
- Office visits represented the primary short-term cost driver, averaging $283 per patient.
Conclusions:
- Elevated blood pressure (BP) is associated with increased physician visit frequency.
- Effective hypertension management can potentially reduce healthcare resource utilization and costs.
- Office visits are a significant component of short-term hypertension management expenses.
Background:
Several studies have reported increased health care resource use among hypertensive patients with uncontrolled blood pressure (BP).
Objective:
The purpose of this study was to investigate the relationship between BP control and health care resource use.
Methods:
Data were obtained from the Caring for Hypertension on Initiation: Costs and Effectiveness (CHOICE) study, a multicenter feasibility study of actual physician and patient behavior and clinical outcomes in a naturalistic setting. Adult patients with newly diagnosed hypertension were randomized to either Group 1 (treatment with diuretics or beta-blockers) or Group 2 (treatment with calcium channel blockers or angiotensin-converting enzyme inhibitors) and followed for 5 +/- 1 months. Physicians practiced standard care while documenting medications, BP measurements, and health care resource use for their patients. A subsequent analysis evaluating the relationship between BP and physician visits was performed for the whole population and for a subpopulation of patients with at least 4 months of follow-up data. Cox regression was used to model time to next visit.
Results:
A total of 512 patients with newly diagnosed hypertension were followed: 399 had follow-up data for at least 4 months. Baseline demographic characteristics were similar in the 2 groups. Kaplan-Meier curves and a log-rank test showed that the time to next visit for patients with uncontrolled BP was significantly shorter than for patients whose BP was controlled (P < 0.05). On average, patients with uncontrolled BP (> or = 140/90 mm Hg) had follow-up office visits approximately 13 days earlier than patients with controlled BP (< 140/90 mm Hg). This association remained significant after adjustment for repeated measures, and after exclusion of the first return visit. Cox regression analysis showed that higher systolic and diastolic BP measurements were significantly associated with a shorter time to next visit, after adjustment for age and sex. Total estimated costs during the study period were $170 per patient for medications and $283 per patient for office visits.
Conclusions:
In the CHOICE study, higher BP was associated with a shorter time to next visit. Office visits were the main cost driver in the short-term management of hypertension.
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Monitoring Both Arms:
Monitoring BP in both arms during the initial assessment is advisable, as the systolic value may differ by five to ten mm Hg between arms. For subsequent BP assessments, use the arm with the higher reading.