Cost analysis of different pharmacological treatment strategies in elderly hypertensives

Abstract

Objective. To compare costs for management of hypertension in elderly hypertensives randomized to starting treatment with conventional (beta‐blockers/diuretics) therapy or a therapy initiated with a calcium antagonist or an angiotensin‐converting enzyme (ACE) inhibitor. Design. Health economic substudy in the Swedish Trial in Old Patients with Hypertension‐2 (STOP Hypertension‐2). Setting. Outpatient clinics in Sweden. In this health economics substudy, 16/312 participating STOP‐2 trial centers were selected. Subjects. Elderly (70–84 years) patients (n = 303) with a systolic and/or diastolic hypertension (⩾180 and/or 105 mmHg). Methods. Costs for patient management were analyzed and categorized in costs for routine care (protocol‐driven costs, PDC), costs for extra visits or care (non‐protocol‐driven costs, NPDC), and direct drug costs (drug treatment costs, DTC). All calculations are related to costs during the first year of treatment after inclusion in STOP Hypertension‐2. Results. Out of the scheduled visits, a total of 99% were actually performed by the patients. There were no differences in the number of visits between the three treatment groups (diuretics/beta‐blockers, calcium antagonists or ACE inhibitors). PDC did thus not differ between the three treatment groups. NPDC were similar in the conventional and calcium antagonist groups and lower than for the ACE inhibitor group. DTC were lower in the conventional treatment group compared with the other two groups. Conclusion. In elderly hypertensives in STOP Hypertension‐2, total costs for management of hypertension were lower in patients assigned to diuretics, beta‐blockers or calcium antagonists compared with ACE inhibitors during the first year of treatment. These results may be relevant to management of elderly hypertensive patients, especially in those patients without compelling indications or contraindications to starting treatment with either of these three main drug alternatives. Notably, with a specific drug regimen there are sizable NPDC such as extra visits and controls associated with symptoms or side‐effects of a specific therapy, which significantly add to the total costs of treatment. Such costs, beyond the actual costs for the drugs, are important to realize and evaluate in order to provide the true costs for treatment of hypertensive patients.