Get access

Cost Implications of Improving Blood Pressure Management among U.S. Adults

Authors

  • Teryl K. Nuckols,

    1. RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA
    Search for more papers by this author
    • Address correspondence to Teryl K. Nuckols, M.D., M.S.H.S., RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA 90407-2138; e-mail: teryl@rand.org. Teryl K. Nuckols is with the Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at the University of California, Los Angeles, CA. Julia E. Aledort, Ph.D., was previously with the RAND Corporation, Santa Monica, CA and is currently with Amylin Pharmaceuticals, San Diego, CA. John Adams, Ph.D., Julie Lai, M.P.H., was previously with the RAND Corporation, Santa Monica, CA and is currently with the Center for Biomedical Modeling, David Geffen School of Medicine at the University of California, Los Angeles, CA. Joan Keesey, and Elizabeth A. McGlynn, Ph.D., are with the RAND Corporation, Santa Monica, CA. Myong-Hyun Go, Ph.D., was previously with the RAND Corporation, Santa Monica, CA, and is currently with the Center for Biomedical Modeling, David Geffen School of Medicine at the University of California, Los Angeles, CA.

  • Julia E. Aledort,

    1. RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA
    Search for more papers by this author
  • John Adams,

    1. RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA
    Search for more papers by this author
  • Julie Lai,

    1. RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA
    Search for more papers by this author
  • Myong-Hyun Go,

    1. RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA
    Search for more papers by this author
  • Joan Keesey,

    1. RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA
    Search for more papers by this author
  • Elizabeth McGlynn

    1. RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA
    Search for more papers by this author

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.

Get access to the full text of this article

Ancillary