sábado, 10 de diciembre de 2011

Cost implications of improving blood pressur... [Health Serv Res. 2011] - PubMed - NCBI

Health Serv Res. 2011 Aug;46(4):1124-57. doi: 10.1111/j.1475-6773.2010.01239.x. Epub 2011 Feb 9.

Cost implications of improving blood pressure management among U.S. adults.

Nuckols TK, Aledort JE, Adams J, Lai J, Go MH, Keesey J, McGlynn E.

Source

RAND Corporation, 1776 Main Street, Santa Monica, CA 90407, USA. teryl@rand.org

Abstract

OBJECTIVE:

To examine the cost-effectiveness of improving blood pressure management from the payer perspective.

DATA SOURCE/STUDY SETTING:

Medical record data for 4,500 U.S. adults with hypertension from the Community Quality Index (CQI) study (1996-2002), pharmaceutical claims from four Massachusetts health plans (2004-2006), Medicare fee schedule (2009), and published literature.

STUDY DESIGN:

A probability tree depicted blood pressure management over 2 years.

DATA COLLECTION/EXTRACTION METHODS:

We determined how frequently CQI study subjects received recommended care processes and attained accepted treatment goals, estimated utilization of visits and medications associated with recommended care, assigned costs based on utilization, and then modeled how hospitalization rates, costs, and goal attainment would change if all recommended care was provided.

PRINCIPAL FINDINGS:

Relative to current care, improved care would cost payers U.S.$170 more per hypertensive person annually (2009 dollars). The incremental cost per person newly attaining treatment goals over 2 years would be U.S.$1,696 overall, U.S.$801 for moderate hypertension, and U.S.$850 for severe hypertension. Among people with severe hypertension, blood pressure would decline substantially but seldom reach goal; the incremental cost per person attaining a relaxed goal (≤ stage 1) would be U.S.$185.

CONCLUSIONS:

Under the Health Care Effectiveness Data and Information Set program, which monitors the attainment of blood pressure treatment goals, payers will find it slightly more cost-effective to improve care for moderate than severe hypertension. Having a secondary, relaxed goal would substantially increase payers' incentive to improve care for severe hypertension.
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