Context Deviation from evidence-based guidelines in hypertension treatment is
common, but its economic impact has not been rigorously studied. Suboptimal
prescribing patterns contribute to the high cost of medications for elderly
patients as well as the difficulty in providing affordable prescription drug
benefits for older Americans.
Objective To calculate the potential savings from the perspective of health care
payers that would result from increased adherence to evidence-based recommendations
for managing hypertension in patients older than 65 years.
Design Comparative analysis of medications prescribed vs potential regimens
suggested by evidence-based guidelines tailored to each patient's medical
history, with calculation of the costs of both the actual and the evidence-based
Setting and Patients A total of 133 624 patients being treated for hypertension during
2001 who were enrolled in a large state pharmaceutical assistance program
that provides prescription drug insurance for elderly persons.
Main Outcome Measure Cost difference between medications actually prescribed and regimens
suggested by evidence-based guidelines.
Results The patients studied filled more than 2.05 million prescriptions for
antihypertensive medications in 2001, at an annual program cost of $48.5 million
($363 per patient). We identified 815 316 prescriptions (40%) for which
an alternative regimen appeared more appropriate according to evidence-based
recommendations. Such changes would have reduced the costs to payers in 2001
by $11.6 million (nearly a quarter of program spending on antihypertensive
medications), as well as being more clinically appropriate overall. Replacement
of calcium channel blockers resulted in the largest potential savings. Use
of pricing limits similar to those in the Medicaid program would have resulted
in even larger potential savings of $20.5 million (42% of program costs).
Conclusions Adherence to evidence-based prescribing guidelines for hypertension
could result in substantial savings in prescription costs for elderly patients
with hypertension that would amount to savings of about $1.2 billion nationally.
Identification of similar areas in which prescribing can be improved will
be critical for the affordability of prescription drug benefit programs.