Hypertension and Common Complications - Analysis of the Ambulatory Treatment Cost

By Ivanova, Anna D.; Petrova, Guenka I. | Central European Journal of Public Health, December 2009 | Go to article overview
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Hypertension and Common Complications - Analysis of the Ambulatory Treatment Cost

Ivanova, Anna D., Petrova, Guenka I., Central European Journal of Public Health


Aim: Retrospective analysis of the prescribing practice and cost of ambulatory treatment of hypertension and its common complications - heart failure, sequelae of cerebrovascular disease, and angina pectoris.

Methods: Analysis of 3,240 reimbursable ambulatory prescriptions for hypertension, heart failure, sequelae of cerebrovascular disease and angina pectoris according to the complexity of the therapy and frequency of the prescribed medicines. Modeling and calculation of the expected monthly cost for outpatient therapy by using the "decision tree model". Sensitivity analysis is performed within the ±30% interval.

Results: 65% of the prescription were forthe hypertension, and 35% forthe observed complications. 1,297 prescriptions for hypertension include one medicine, 647 include two medicines, and only 8% of prescriptions were for three medicines. ACE inhibitors have been prescribed in 41% of all hypertension prescriptions, followed by beta-blockers (19%), Ca channel blockers (16%), diuretics (15%) etc. The prescriptions for hypertension complications are more diverse as therapeutic groups. The expected monthly cost of prescribed medicines per patient with hypertension alone is 6.90 euro and in case of complications it is 10.71 euro according to the prevalence of the complexity of therapy, and weighted monthly cost of medicines. The overall ambulatory cost is expected to be around 148 million euro per year for near 1.5 million patients with 44% reimbursement. The cost of the therapy is sensitive more to changes in the medicine's prices than to its complexity.

Conclusion: This study is a first step in providing information for evidence-based cost containment measures or policy decisions at ambulatory level in Bulgaria and for the assessment of the share of complications' therapy on the overall hypertension cost.

Key words: hypertension cost, prescription habits, angina pectoris cost, heart failure cost, stroke cost, cost modeling


High blood pressure is the most common chronic medical problem and hypertension is an important public-health challenge world-wide. Overall, 26.4% of the adult population in 2000 had hypertension and it is expected that 26. 1% of women, and 29.2% of men will have this condition by 2025 year worldwide (1). In Europe the hypertension was found to be more prevalent than in USA and Canada and poor controlled (2-5). Hypertension is a major global economic burden because of an increased risk for cardiovascular events and inadequately controlled high blood pressure raises the medical, economic, and human costs.

Age-standardized mortality rate for cardiovascular diseases is 554.0 per 100,000 Bulgarian population (6) and hypertension is the leading cause for death (108.1 per 100, 000) (7) and its complication leads to age-standardized annual event rate from 915 to 30 per 100, 000 people all over the world (8, 9). The high social and medical importance of hypertension underlines the economic impact of the therapy of hypertensive patients at national and international level.

There have not been found studies on the cost of hypertension therapy in Bulgaria and this stimulated us to perform the current study. In 2004 the National Health Insurance Fund published information that the hypertension is one of the leading 10 diagnoses accounting for near 20 million euro expenditures per year. Till then no such information was publicly available (10). In addition to the cost analysis we also want to explore the impact of the hypertension medication therapy. The problem is important from the point of view of the financing institutions in order to make them understand the variables influencing the changes in the hypertension therapy cost.


Researchers are studying the social and economic impact of hypertension at national level in many different ways (1 1-15). They calculate the direct and indirect cost of hypertension and/or complications cost, analyze prescribing practice and changes in cost of therapy, as well as create different cost models.

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