[When is it worth reducing overuse of health care services? The example of prescribing expensive antihypertensives].
OBJECTIVE
Reducing overuse of health care services saves costs only if implementation costs are lower than savings from avoided health care services. Predicting the expected net benefit helps policymakers to make a choice among the various overuse problems and components of implementation programs in health care. The goal of this paper is to demonstrate how to calculate the net benefit of reducing overuse. In an application example feedback or outreach visits to primary care physicians in Germany reduce the prescription of expensive antihypertensives with questionable benefit.


METHODS
In a mathematical model secondary data were used to portray the relationship between the net benefit from reducing overuse and the degree of overuse.


RESULTS
Assuming that currently 30% of treated hypertensive patients could switch to thiazides and combinations with other drugs, an overuse reduction through feedback or outreach visits to primary care physicians is efficient.


CONCLUSIONS
If the degree of overuse is large, an overuse reduction can be efficient. The explicit consideration of the size of an overuse problem may contribute to a more efficient use of health care resources.
Gandjour
Afschin
A
Institut für Gesundheitsökonomie und Klinische Epidemiologie, Universität zu Köln, Gleueler Strasse 176-178, 50935 Köln. afschin.gandjour@medizin.uni-koeln.de
Lauterbach
Karl Wilhelm
KW
D000293:Adolescent; D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use; D017046:Cost Savings; D011307:Drug Prescriptions / Q000191:economics; D004359:Drug Therapy, Combination; D005260:Female; D005858:Germany; D006295:Health Resources / Q000706:statistics & numerical data; D006296:Health Services / Q000191:economics / Q000706:statistics & numerical data*; D006300:Health Services Misuse / Q000191:economics; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000191:economics / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D010349:Patient Compliance; D015995:Prevalence; D011320:Primary Health Care; D016032:Randomized Controlled Trials as Topic; D049993:Sodium Chloride Symporter Inhibitors / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use
D000959:Antihypertensive Agents; D049993:Sodium Chloride Symporter Inhibitors