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Cost analysis of different pharmacological treatment strategies in elderly hypertensives
Erland Linjer1, Thomas Hedner, Bengt Jönsson
1Department of Clnical Pharmacology, The Sahlgrenska Academy at Göteborg University, Sahlgrenska University Hospital, Göteborg, Sweden. erland.linjer@pharm.gu.se
Insights
In elderly patients with hypertension, initiating treatment with conventional therapies (beta-blockers/diuretics) or calcium antagonists resulted in lower total management costs compared to angiotensin-converting enzyme (ACE) inhibitors during the first year. Non-protocol driven costs significantly impact overall treatment expenses.
Area of Science:
- Gerontology
- Cardiovascular Medicine
- Health Economics
Background:
- Hypertension management in the elderly presents unique cost considerations.
- Treatment choices for hypertension in older adults can influence overall healthcare expenditure.
- Understanding the economic impact of different antihypertensive drug classes is crucial for resource allocation.
Purpose of the Study:
- To compare the costs associated with managing hypertension in elderly patients.
- To evaluate the economic differences between initiating treatment with conventional therapies (beta-blockers/diuretics), calcium antagonists, or angiotensin-converting enzyme (ACE) inhibitors.
- To analyze cost components including routine care, non-protocol driven care, and direct drug costs.
Main Methods:
- A health economic substudy of the Swedish Trial in Old Patients with Hypertension-2 (STOP Hypertension-2).
- Inclusion of elderly patients (70-84 years) with hypertension (systolic/diastolic ge 180/ge 105 mmHg).
- Analysis of patient management costs during the first year of treatment, categorized into protocol-driven costs (PDC), non-protocol-driven costs (NPDC), and direct drug costs (DTC).
Main Results:
- No significant differences in protocol-driven costs (PDC) were observed between the treatment groups.
- Non-protocol-driven costs (NPDC) were similar for conventional and calcium antagonist groups, but lower than for the ACE inhibitor group.
- Direct drug costs (DTC) were lower in the conventional treatment group compared to calcium antagonist and ACE inhibitor groups.
Conclusions:
- Total costs for hypertension management in elderly patients were lower with diuretics, beta-blockers, or calcium antagonists compared to ACE inhibitors in the first year of treatment.
- Non-protocol-driven costs, such as extra visits for symptoms or side effects, significantly contribute to total treatment costs.
- These findings are relevant for managing elderly hypertensive patients, particularly when there are no strong indications or contraindications for specific drug classes.
Objective:
To compare costs for management of hypertension in elderly hypertensives randomized to starting treatment with conventional (beta-blockers/diuretics) therapy or a therapy initiated with a calcium antagonist or an angiotensin-converting enzyme (ACE) inhibitor.
Design:
Health economic substudy in the Swedish Trial in Old Patients with Hypertension-2 (STOP Hypertension-2).
Setting:
Outpatient clinics in Sweden. In this health economics substudy, 16/312 participating STOP-2 trial centers were selected.
Subjects:
Elderly (70--84 years) patients (n=303) with a systolic and/or diastolic hypertension (or=180 and/or 105 mmHg).
Methods:
Costs for patient management were analyzed and categorized in costs for routine care (protocol-driven costs, PDC), costs for extra visits or care (non-protocol-driven costs, NPDC), and direct drug costs (drug treatment costs, DTC). All calculations are related to costs during the first year of treatment after inclusion in STOP Hypertension-2.
Results:
Out of the scheduled visits, a total of 99% were actually performed by the patients. There were no differences in the number of visits between the three treatment groups (diuretics/beta-blockers, calcium antagonists or ACE inhibitors). PDC did thus not differ between the three treatment groups. NPDC were similar in the conventional and calcium antagonist groups and lower than for the ACE inhibitor group. DTC were lower in the conventional treatment group compared with the other two groups. CONCLUSION. In elderly hypertensives in STOP Hypertension-2, total costs for management of hypertension were lower in patients assigned to diuretics, beta-blockers or calcium antagonists compared with ACE inhibitors during the first year of treatment. These results may be relevant to management of elderly hypertensive patients, especially in those patients without compelling indications or contraindications to starting treatment with either of these three main drug alternatives. Notably, with a specific drug regimen there are sizable NPDC such as extra visits and controls associated with symptoms or side-effects of a specific therapy, which significantly add to the total costs of treatment. Such costs, beyond the actual costs for the drugs, are important to realize and evaluate in order to provide the true costs for treatment of hypertensive patients.
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