Skip to main content
Log in

A Review of Cost-Effectiveness Analyses of Hypertension Treatment

  • Review Article
  • Published:
PharmacoEconomics Aims and scope Submit manuscript

Summary

In this paper cost-effectiveness analyses of hypertension treatment are reviewed. Nine studies using life-years gained or quality-adjusted life-years gained as outcome measure are identified, summarised, and their results analysed. It is noted that there is a lack of methodological conformity between the studies, which makes comparisons difficult. The only consistent finding among the studies is that the cost-effectiveness increased with higher pretreatment blood pressure. The studies also indicated that treatment of hypertension is more cost-effective in younger men than in younger women, and that cost-effectiveness increases with age for both men and women. It is impossible at present to draw any policy conclusions from the cost-effectiveness analyses comparing different drugs, owing to poor methodology and insufficient data. For the future it is important to upgrade the quality of the cost-effectiveness analyses in this area by improving both the data and the methodology used. There is also a need to complement cost-effectiveness analysis with other approaches, for example willingness to pay.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  • Black HR. The coronary artery disease paradox: the role of hyperinsulinemia and insulin resistance and implications for therapy. Journal of Cardiovascular Pharmacology 15 (Suppl. 5): S26–S38, 1990

    PubMed  Google Scholar 

  • Chambless LE, Dobson AJ, Patterson CC, Raines B. On the use of a logistic risk score in predicting risk of coronary heart disease. Statistics in Medicine 9: 385–396, 1990

    Article  PubMed  CAS  Google Scholar 

  • Collins R, Peto R, MacMahon S, Hebert P, Fiebach NH, et al. Blood pressure, stroke, and coronary heart disease. Part 2. Short term reductions in blood pressure: overview of randomised drug trials in their epidemiological context. Lancet 335: 827–838, 1990

    Article  PubMed  CAS  Google Scholar 

  • Dahlöf B, Lindholm LH, Hansson L, Scherstén B, Ekbom T, et al. Morbidity and mortality in the Swedish trial in old patients with hypertension (STOP-Hypertension). Lancet 338: 1281–1285, 1991

    Article  PubMed  Google Scholar 

  • Drummond MF, Torrance GL, Stoddart GW. Methods for the Economic Evaluation of Healthcare Programmes. Oxford University Press, Oxford, 1987

    Google Scholar 

  • Edelson JT, Weinstein MC, Tosteson AN, Williams L, Lee TH, et al. Long-term cost-effectiveness of various initial monotherapies for mild to moderate hypertension. Journal of the American Medical Association 263: 407–413, 1990

    Article  PubMed  CAS  Google Scholar 

  • Edgar MA, Schnieden H. The economics of mild hypertension programmes. Social Science and Medicine 28: 211–222, 1989

    Article  PubMed  CAS  Google Scholar 

  • Fletcher AE, Bulpitt CJ. Pharmacoeconomic evaluation of risk factors for cardiovascular disease: an epidemiological perspective. PharmacoEconomics 1: 33–44, 1992

    Article  PubMed  CAS  Google Scholar 

  • Freund DA, Dittus RS. Principles of pharmacoeconomic analysis of drug therapy. PharmacoEconomics 1: 20–29, 1992

    Article  PubMed  CAS  Google Scholar 

  • Johannesson M. Economic evaluation of hypertension treatment. International Journal of Technology Assessment in Health Care, in press, 1992a

    Google Scholar 

  • Johannesson, M. A note on the discounting of gained life-years in cost-effectiveness analysis. International Journal of Technology Assessment in Health Care, in press, 1992b

    Google Scholar 

  • Johannesson M, Borgquist L, Jönsson B, Råstam L. The costs of treating hypertension: an analysis of different cut-off points. Health Policy 18: 141–150, 1991a

    Article  PubMed  CAS  Google Scholar 

  • Johannesson M, Borgquist L, Jönsson B. The costs of treating hypertension in Sweden: an empirical investigation in primary health care. Scandinavian Journal of Primary Health Care 9: 155–160, 1991b

    Article  PubMed  CAS  Google Scholar 

  • Johannesson M, Hedbrant J, Jönsson B. A computer simulation model for cost-effectiveness analysis of cardiovascular disease prevention. Medical Informatics 16: 355–362, 1991c

    Article  PubMed  CAS  Google Scholar 

  • Johannesson M, Jönsson B. Cost-effectiveness analysis of hypertension treatment: a review of methodological issues. Health Policy 19: 55–78, 1991a

    Article  PubMed  CAS  Google Scholar 

  • Johannesson M, Jönsson B. Economic evaluation in health care: is there a role for cost-benefit analysis? Health Policy 17: 1–23, 1991b

    Article  PubMed  CAS  Google Scholar 

  • Johannesson M, Johansson P-O, Jönsson B. Economic evaluation of drug therapy. A review of the contingent valuation method. PharmacoEconomics, in press, 1992

  • Johannesson M, Jönsson B, Borgquist L. Willingness to pay for antihypertensive therapy: results of a Swedish pilot study. Journal of Health Economics 10: 461–474, 1991e

    Article  PubMed  CAS  Google Scholar 

  • Johannesson M, Åberg H, Agréus L, Borgquist L, Jönsson B. Cost-benefit analysis of non-pharmacological treatment of hypertension. Journal of Internal Medicine 230: 307–312, 1991d

    Article  PubMed  CAS  Google Scholar 

  • Kannel WB, Wolf PA, Garrison RJ, (eds). The Framingham study: an epidemiological investigation of cardiovascular disease. Section 34: Some risk factors related to the annual incidence of cardiovascular disease and death using pooled repeated biennial measurements, 30 year follow up. U.S. Department of Commerce, National Technical Information Service, Springfield, 1987

    Google Scholar 

  • Kawachi I, Malcolm LA. The cost-effectiveness of treating mild-to-moderate hypertension: a reappraisal. Journal of Hypertension 9: 199–208, 1991

    Article  PubMed  CAS  Google Scholar 

  • Keys A. Seven countries. Harvard University Press, Cambridge Massachusetts, 1980

    Google Scholar 

  • Laaser U, Wenzel H. Antihypertensive treatment in Germany, subjected to a cost-effectiveness analysis. Journal of Human Hypertension 4: 436–440, 1990

    PubMed  CAS  Google Scholar 

  • Lindgren B, Persson U. The cost-effectiveness of a new antihypertensive drug, doxazosin. Current Therapeutic Research 45: 738–760, 1989

    Google Scholar 

  • Littenberg B, Garber AM, Sox HC. Screening for hypertension. Annals of Internal Medicine 112: 192–202, 1990

    PubMed  CAS  Google Scholar 

  • Logan AG, Milne BJ, Achber C, Campbell WP, Haynes RB. Cost-effectiveness of a worksite hypertension treatment programme. Hypertension 3: 211–218, 1981

    Article  PubMed  CAS  Google Scholar 

  • Logan AG, Milne BJ, Flanagan PT, Haynes RB. Clinical effectiveness and cost-effectiveness of monitoring blood pressure of hypertensive employees at work. Hypertension 5: 828–836, 1983

    Article  PubMed  CAS  Google Scholar 

  • MacMahon S, Peto R, Cutler J, Collins R, Sorlie P, et al. Blood pressure, stroke, and coronary heart disease, part 1. Prolonged differences in blood pressure: prospective observational studies corrected for the regression dilution bias. Lancet 335: 765–774, 1990

    Article  PubMed  CAS  Google Scholar 

  • Mitchell RC, Carson RT. Using surveys to value public goods. Resources for the Future, Washington D.C., 1989

    Google Scholar 

  • Nissinen A, Tuomilehto J, Kottke TE, Puska P. Cost-effectiveness of the North Karelia hypertension program 1972–1977. Medical Care 24: 767–780, 1986

    Article  PubMed  CAS  Google Scholar 

  • Organisation for Economic Cooperation and Development (OECD). Financing and delivering health care, a comparative analysis of OECD countries. OECD, Paris, 1987

    Google Scholar 

  • Simes RJ, Glasziou PP. Meta-analysis and quality of evidence in the economic evaluation of drug trials. PharmacoEconomics 1(4): 282–292, 1992

    Article  PubMed  CAS  Google Scholar 

  • Statistics Sweden. Statistical abstract of Sweden 1990. Statistics Sweden, Stockholm, 1989

    Google Scholar 

  • Stevens RD, Bingley Jr LJ, Boger M, El-Wanni J, Kaston J. Variability in the management of hypertension and cost-effectiveness: methodology, community care results and potential cost reductions. Social Science and Medicine 18: 767–774, 1984

    Article  PubMed  CAS  Google Scholar 

  • Weinstein MC, Coxson PG, Williams LW, Pass TM, Stason WB et al. Forecasting coronary heart disease incidence, mortality, and cost: the coronary heart disease policy model. American Journal of Public Health 77: 1417–1426, 1987

    Article  PubMed  CAS  Google Scholar 

  • Weinstein MC, Stason WB. Hypertension: a policy perspective. Harvard University Press, Cambridge Massachusetts, 1976

    Google Scholar 

  • Weinstein MC, Stason WB. Allocation of resources to manage hypertension. New England Journal of Medicine 296: 732–739, 1977

    Article  PubMed  Google Scholar 

  • Wikstrand J, Warnold I, Tuomilehto J, Olsson G, Elmfeldt D, et al. Metoprolol versus thiazide diuretics in hypertension: morbidity results from the MAPHY study. Hypertension 17: 579–588, 1991

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Johannesson, M., Jönsson, B. A Review of Cost-Effectiveness Analyses of Hypertension Treatment. Pharmacoeconomics 1, 250–264 (1992). https://doi.org/10.2165/00019053-199201040-00003

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00019053-199201040-00003

Keywords

Navigation