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.
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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
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
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
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
Drummond MF, Torrance GL, Stoddart GW. Methods for the Economic Evaluation of Healthcare Programmes. Oxford University Press, Oxford, 1987
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
Edgar MA, Schnieden H. The economics of mild hypertension programmes. Social Science and Medicine 28: 211–222, 1989
Fletcher AE, Bulpitt CJ. Pharmacoeconomic evaluation of risk factors for cardiovascular disease: an epidemiological perspective. PharmacoEconomics 1: 33–44, 1992
Freund DA, Dittus RS. Principles of pharmacoeconomic analysis of drug therapy. PharmacoEconomics 1: 20–29, 1992
Johannesson M. Economic evaluation of hypertension treatment. International Journal of Technology Assessment in Health Care, in press, 1992a
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
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
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
Johannesson M, Hedbrant J, Jönsson B. A computer simulation model for cost-effectiveness analysis of cardiovascular disease prevention. Medical Informatics 16: 355–362, 1991c
Johannesson M, Jönsson B. Cost-effectiveness analysis of hypertension treatment: a review of methodological issues. Health Policy 19: 55–78, 1991a
Johannesson M, Jönsson B. Economic evaluation in health care: is there a role for cost-benefit analysis? Health Policy 17: 1–23, 1991b
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
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
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
Kawachi I, Malcolm LA. The cost-effectiveness of treating mild-to-moderate hypertension: a reappraisal. Journal of Hypertension 9: 199–208, 1991
Keys A. Seven countries. Harvard University Press, Cambridge Massachusetts, 1980
Laaser U, Wenzel H. Antihypertensive treatment in Germany, subjected to a cost-effectiveness analysis. Journal of Human Hypertension 4: 436–440, 1990
Lindgren B, Persson U. The cost-effectiveness of a new antihypertensive drug, doxazosin. Current Therapeutic Research 45: 738–760, 1989
Littenberg B, Garber AM, Sox HC. Screening for hypertension. Annals of Internal Medicine 112: 192–202, 1990
Logan AG, Milne BJ, Achber C, Campbell WP, Haynes RB. Cost-effectiveness of a worksite hypertension treatment programme. Hypertension 3: 211–218, 1981
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
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
Mitchell RC, Carson RT. Using surveys to value public goods. Resources for the Future, Washington D.C., 1989
Nissinen A, Tuomilehto J, Kottke TE, Puska P. Cost-effectiveness of the North Karelia hypertension program 1972–1977. Medical Care 24: 767–780, 1986
Organisation for Economic Cooperation and Development (OECD). Financing and delivering health care, a comparative analysis of OECD countries. OECD, Paris, 1987
Simes RJ, Glasziou PP. Meta-analysis and quality of evidence in the economic evaluation of drug trials. PharmacoEconomics 1(4): 282–292, 1992
Statistics Sweden. Statistical abstract of Sweden 1990. Statistics Sweden, Stockholm, 1989
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
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
Weinstein MC, Stason WB. Hypertension: a policy perspective. Harvard University Press, Cambridge Massachusetts, 1976
Weinstein MC, Stason WB. Allocation of resources to manage hypertension. New England Journal of Medicine 296: 732–739, 1977
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
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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
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DOI: https://doi.org/10.2165/00019053-199201040-00003