Risk factor profile and achievement of treatment goals among hypertensive patients from the Israeli Blood Pressure Control (IBPC) program--initial cost utility analysis.
OBJECTIVE
Blood pressure (BP) reduction is crucial in reducing cardiovascular morbidity and mortality. The IBPC (Israeli Blood Pressure Control) program was initiated in order to enhance the control of modifiable risk factors among high-risk hypertensive patients under follow-up by general practitioners in Israel. The cost effectiveness of an intervention program is an important factor in the decision-making process of its implementation and therefore was evaluated here. The objective of this evaluation is to estimate the costs, monetary savings and benefits in terms of QALYs (quality-adjusted life years) that would be expected if the program were to be expanded to 100 clinics nationwide, enabling around 14800 persons to be treated.


METHODS
Hypertensive patients were screened in 30 general practice clinics, supervised by specialists in family medicine, each seeing 1000-5000 patients; 50-250 hypertensive patients were diagnosed at each participating clinic. BP levels, body mass index (BMI), lipid and glucose levels, as well as target organ damage and medications were recorded for all patients.


RESULTS
A total of 4948 (2079, 42% males) were registered. Mean age was 64.8 +/- 12 years. After 1 year of follow-up versus baseline, the various parameters were as follows: BP control was achieved in 46.4% vs 29% of all hypertensive patients. LDL control (JNC VI criteria) was achieved in 41.7% vs 31.2% of all patients. Fasting plasma glucose control (glucose < 126 mg/dl) was achieved in 22% vs 19% of diabetic patients and 5.2% vs 3.1% of the diabetics had fasting plasma glucose levels > 200 mg/dl. Obesity (BMI > 30 kg/m2) was noted in 36.7% vs 43.8% at baseline. The cost utility analysis of the reduction in risk factors was calculated based on the international dicta applied to the reduction in risk factors as a result of treatment. For 100 clinics nationwide and 14800 persons to be treated the net saving to health services would be $977993 and the increase in QALYs would be 602 years.


CONCLUSIONS
Better risk factor control in hypertensive patients by general practitioners could reduce morbidity and mortality as well as be cost effective.
WHO Collaborative Center for Prevention and Treatment of Cardiovascular Disease, Barzilai Medical Center Campus, Ben-Gurion University of the Negev, Ashkelon, Israel. yosefy@barzi.health.gov.il
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Yosefy
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Ginsberg
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Dicker
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Viskoper
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Tulchinsky
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Leibovitz
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Gavish
D000368:Aged; D001786:Blood Glucose; D001794:Blood Pressure / Q000502:physiology*; D015992:Body Mass Index; D008076:Cholesterol, HDL / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood; D003362:Cost-Benefit Analysis; D005194:Family Practice / Q000191:economics / Q000193:education; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D006973:Hypertension / Q000453:epidemiology / Q000503:physiopathology / Q000517:prevention & control*; D007557:Israel / Q000453:epidemiology; D008297:Male; D008403:Mass Screening / Q000191:economics / Q000379:methods; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000517:prevention & control; D009765:Obesity / Q000175:diagnosis; D018579:Patient Selection; D015995:Prevalence; D019057:Quality-Adjusted Life Years; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology / Q000517:prevention & control; D016896:Treatment Outcome; D014280:Triglycerides / Q000097:blood
D001786:Blood Glucose; D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D014280:Triglycerides