Academic journal article Bulletin of the World Health Organization

Economics of Hypertension Control

Academic journal article Bulletin of the World Health Organization

Economics of Hypertension Control

Article excerpt


The fact that high blood pressure is relatively common in developed countries, together with the results of treatment in randomized trials (1), has led to a rapid growth in antihypertensive drug treatment with an increasing trend for more expensive drugs to be prescribed. For example, there was in France a six-fold increase in the diagnosis of hypertension between 1970 and 1990, and a tenfold increase in antihypertensive medication expenditure (2). As developing countries undergo the transition to the disease pattern of developed countries, cardiovascular diseases are becoming proportionately more important as a cause of morbidity and mortality, and the control of hypertension will become an issue in many countries. The increasing cost due to or relating to hypertension is thus a reality so that, even in the most affluent countries, owing to resource constraints the strategies for hypertension control have to compete with other health care interventions and other needs of society.

Concerned with these issues, the World Hypertension League convened an International Workshop on the Economics of Hypertension Control in Barcelona, Spain, in September 1991, details of which with recommendations have been published (3). This paper summarizes the key aspects of the Workshop proceedings, which include estimation of the economic burden of hypertension and hypertension-related disease, the use of economic models to establish public health strategies for the control of hypertension, and identification of opportunities for cost containment.

Burden of hypertension and

hypertension-related disease

The economic burden of disease has traditionally been measured in terms of (i) the direct costs of health care and other resources used to treat the disease, (ii) the indirect costs or economic consequences of the illness, such as loss of income, and (iii) intangible costs relating to the levels of impairment or reduction in the quality of life of the individual (4). The economic burden of hypertension is considerable because it includes not only the costs arising from the treatment of hypertension itself, but the burden of hypertension-related disease, the best-documented example of which is stroke and coronary heart disease (CHD).

The population-attributable risk (PAR) is a method of expressing the extent to which the burden of disease in a population results from a particular risk factor. Thus, theoretically a PAR of 100% would mean that all the disease burden was attributable to the risk factor, and 0% would mean that none of the burden was attributable to the risk factor. The PAR in our present analysis depends on the definition and prevalence of hypertension in a population, and the risk associated with that particular blood pressure level derived from prospective studies (5). In a typical developed country, such as Australia, the PAR for hypertension (38% prevalence of diastolic blood pressure (DBP) of [greater than or equal to]90% mmHg, based on a single reading) has been estimated as 36% for stroke and 22% for CHD (6). PARs for DBPs of [greater than or equal to]95mmHg (20% prevalence) were 30% for stroke and 18% for CHD, and for DBPs of [greater than or equal to]100 mmHg (11% prevalence) they were 22% for stroke and 13% for CHD. Moreover, it is likely that the PARs for stroke and CHD underestimate the burden of disease which is related to hypertension since vascular dementia, heart failure, peripheral vascular disease, and end-stage renal failure are also, to some extent, the consequence of a raised blood pressure.

Data from developing countries indicate a high prevalence of hypertension in many communities, e.g., reports from urban areas in Brazil and Thailand of DBP of [greater than or equal to]95 mmHg in 20% of the surveyed population (7, 8). As more precise information on stroke and CHD rates becomes available from countries, the estimation of the PAR due to hypertension and the relative importance of CHD and stroke as causes of morbidity and mortality will assist the debate on determining health priorities in those countries. …

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