Antihypertensives: Boon or bane ?
A study published recently in the New England Journal of Medicine evaluated the cost-effectiveness of treating hypertension based on the most recent JNC 8 guidelines. The study was interesting in that a previous similar analysis had found that screening for and treating hypertension does not save money. The upfront costs of the doctor’s fee, lab costs, and invariably life-long prescriptions, were greater than the projected savings down the road from fewer cases of heart disease and strokes. But this NEJM study is a bit different and claims that in some cases it does save money….. and it got me curious !
The study was based on the sophisticated Markov-based model. Much care has been taken to simulate various real-world scenarios, with separate results for each scenario. Phew! But let us just look at what it means for people in the age bracket of 34 to 59. For men in this group, screening and treating hypertension was found to be cost-saving, but for women it was not.
To cut a long story short; the data presented for this age-group implies that if the people in this age range were treated for hypertension, the vast majority of people will not be affected at all. For men, the cost savings was 2% ($600 million out of $33 billion!!!) and it yielded 25,000 (.05%) more quality adjusted life years (QALYs) out of 2.3 million patients. (More coming on the QALYs in my next post) For women the costs went up slightly (0.4%) and the number of quality-adjusted life years increased by 0.02%. Of course, the benefit had to be higher for older persons, diabetics, et al. and more so in stage 2 hypertension. But the overall finding that there were no dramatic differences in the treatment groups was rather unchanged.
Lets look at it from a different angle – the public health perspective: A recent report pegged the average cost of coronary artery bypass surgery in the US at $75,345. Compare this with the cost of the same surgery in, say, Netherlands [$15,742 (about 79% lower)], and you will know what we are talking about here. The cost of angiography alone is about $900 in U.S. versus $174 (down by 81%) in the Netherlands. That the other developed countries usually do much fewer procedures than in the U.S. is an aggravating factor.
For those advocating for more and better primary care in US (which is clearly required), they should be mindful of the fact that screening and treating a common disease such as hypertension alone does not explain the cost savings and better outcomes with primary care. Its not to suggest that screening for hypertension in primary care should stop. Actually, it does help a little. But should this issue not be articulated in the main policy agenda …and in the debates aimed at making US health care more affordable? But that part is clearly missing! Here’s a link to a related video on the effect of revised 2014 guidelines on hypertension in US.
Before closing, a cartoon from americanpowerblog.blogspot.com that went viral back in 2013, and hilariously sums up the bane of US health care. At that time much of Obamacare was still in the pipeline. And here’s another interesting take on the costs of health care in U.S.
… To be concluded