An economic evaluation of the JNC hypertension guidelines using data from a randomized controlled trial. Joint National Committee.
BACKGROUND
We wanted to determine the clinical cost of managing hypertension when following the Joint National Committee on Hypertension (JNC) guidelines, including drug therapy, the cost of monitoring for and treating side effects, compliance, and the cost of switching after therapeutic failures.


METHODS
The base-case analysis considers antihypertensive agents from four therapeutic classes that were recently evaluated in a large randomized trial: enalapril, amlodipine, acebutolol, and chlorthalidone. Clinical evaluation, therapy, and monitoring for hypertension are modeled with an incidence-based Markov model. Clinical inputs include agent efficacy, side effects, and compliance with dosing schedules. JNC-recommended clinical and laboratory monitoring schedules are followed for each agent. Switches between classes occur for therapeutic failures. Drug and medical care costs are valued in 1995 US dollars.


RESULTS
Although patients whose hypertension was initially treated with amlodipine achieved control more readily than patients who were given the other agents, the initial costs to achieve and maintain hypertension control were lowest for chlorthalidone ($641), followed by acebutolol ($920), amlodipine ($946), and enalapril ($948). Maintenance costs were lowest for chlorthalidone. For all agents except chlorthalidone, drug costs were the largest component of overall costs, followed by the costs of office visits, laboratory monitoring, and switching between classes for therapeutic failures.


CONCLUSIONS
By following JNC guidelines, a slightly higher percentage of patients will achieve hypertension control with a newer class calcium channel blocker (amlodipine) but at a substantially higher cost than with a generic diuretic (chlorthalidone).
Ramsey
S D
SD
Department of Medicine, University of Washington, Seattle, USA.
Neil
N
N
Sullivan
S D
SD
Perfetto
E
E
D000070:Acebutolol / Q000191:economics / Q000627:therapeutic use; D000319:Adrenergic beta-Antagonists / Q000191:economics / Q000627:therapeutic use; D000328:Adult; D017311:Amlodipine / Q000191:economics / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000191:economics / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000191:economics / Q000627:therapeutic use*; D002121:Calcium Channel Blockers / Q000191:economics / Q000627:therapeutic use; D002752:Chlorthalidone / Q000191:economics / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D003657:Decision Making; D003661:Decision Support Techniques; D004232:Diuretics / Q000191:economics / Q000627:therapeutic use; D004656:Enalapril / Q000191:economics / Q000627:therapeutic use; D017048:Health Care Costs; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000191:economics*; D017410:Practice Guidelines as Topic; D016032:Randomized Controlled Trials as Topic
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D002121:Calcium Channel Blockers; D004232:Diuretics; D017311:Amlodipine; D000070:Acebutolol; D004656:Enalapril; D002752:Chlorthalidone