Document Detail

Cost-effectiveness of the lower treatment goal (of JNC VI) for diabetic hypertensive patients. Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure.
MedLine Citation:
PMID:  10809030     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: The recommendation of the Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI) to lower blood pressure (BP) in diabetic patients to less than 130/85 mm Hg may have negative economic consequences. A formal cost-effectiveness analysis was therefore performed, comparing the costs and potential benefits of a BP goal of less than 140/90 mm Hg (as recommended by JNC V) vs less than 130/85 mm Hg (as inJNC VI). METHODS: A 24-cell computer model was populated with costs (1996 dollars), relative risks, and age-specific base-line rates for death and 4 nonfatal adverse events (stroke, myocardial infarction, heart failure, and end-stage renal disease), derived from published data. Costs and benefits were discounted at 3%. RESULTS: For 60-year-old diabetic persons with hypertension, treating to the lower BP goal increases life expectancy by 0.48 (discounted) years and lowers (discounted) lifetime medical costs by $1450 compared with treating BP to less than 140/90 mm Hg. The lower treatment BP goal results in an overall cost savings over a wide range of initial conditions, and for nearly all analyses for patients older than 60 years. CONCLUSIONS: Any incremental treatment for 60-year-olds that costs less than $414 annually and successfully lowers BP from below 140/90 to below 130/85 mm Hg would be cost saving in the long term, due to the reduction in attendant costs of future morbidity. The lower treatment goal recommended for high-risk hypertensive patients compares favorably in cost-effectiveness with many other frequently recommended treatment strategies, and saves money overall for patients aged 60 years and older.
W J Elliott; D R Weir; H R Black
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Archives of internal medicine     Volume:  160     ISSN:  0003-9926     ISO Abbreviation:  Arch. Intern. Med.     Publication Date:  2000 May 
Date Detail:
Created Date:  2000-05-30     Completed Date:  2000-05-30     Revised Date:  2007-11-14    
Medline Journal Info:
Nlm Unique ID:  0372440     Medline TA:  Arch Intern Med     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1277-83     Citation Subset:  AIM; IM    
Department of Preventive Medicine, Rush Medical College of Rush University at Rush-Presbyterian-St Luke's Medical Center, Chicago, IL, 60612-3624, USA.
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MeSH Terms
Aged, 80 and over
Antihypertensive Agents / economics*,  therapeutic use
Computer Simulation*
Cost-Benefit Analysis
Diabetes Mellitus / drug therapy*,  economics
Drug Therapy / economics
Hypertension / drug therapy*,  economics
Middle Aged
Grant Support
Reg. No./Substance:
0/Antihypertensive Agents

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