title: Partial cost-benefit analysis of two different modes of nonpharmacological control of hypertension in the community.
abstract: In the Dan and Ashkelon areas of Israel, 28 male and 24 female mild to moderate hypertensives without target organ damage aged 35-65 years were randomly assigned to treatment programmes (based on nutritional management, exercise and stress management techniques) either on an individual basis administered by physician-nurse teams (PN) or on a group basis from a team of paramedical professionals (PP) consisting of a psychologist, nutritionist and physical activity instructor. At 11 and 24 months follow-up, there were similar significant improvements in both treatment modes for such risk factors as body mass index, caloric intake and physical activity levels. There was a significant decrease in drug use from $36.28 a month at baseline to $18.94 a month at 11 month follow-up (P = 0.01) and to an estimated $20.48 at 24 months. Mean BP remained unchanged, despite the reduction in drug use, indicating a reduction in the underlying BP. The net present value (NPV) of the reduction in drug utilisation totalled $740 per person over a five year time horizon and a 7.5% discount rate. The total extra costs of treatment, training, case-note writing, travelling and follow-up booster sessions, amounted to $95 per patient for the PN mode and $234 per patient for the PP mode, yielding benefit to cost ratios of 7.79/1 and 3.16/l, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Department of Data Analysis, Ministry of Health, Jerusalem, Israel.
authors.forename: G M
authors.initials: GM
authors.lastname: Ginsberg
authors.forename: J R
authors.initials: JR
authors.lastname: Viskoper
authors.forename: Z
authors.initials: Z
authors.lastname: Fuchs
authors.forename: I
authors.initials: I
authors.lastname: Drexler
authors.forename: F
authors.initials: F
authors.lastname: Lubin
authors.forename: S
authors.initials: S
authors.lastname: Berlin
authors.forename: H
authors.initials: H
authors.lastname: Nitzan
authors.forename: L
authors.initials: L
authors.lastname: Zulty
authors.forename: A
authors.initials: A
authors.lastname: Chetrit
authors.forename: L
authors.initials: L
authors.lastname: Bregman
mesh_terms: D000328:Adult; D000368:Aged; D000488:Allied Health Personnel; D002985:Clinical Protocols; D003154:Community Medicine / Q000191:economics* / Q000379:methods; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D006973:Hypertension / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D009726:Nurses; D010348:Patient Care Team; D010820:Physicians