Cost-effectiveness analysis of guidelines for antihypertensive care in Finland.
BACKGROUND
Hypertension is one of the major causes of disease burden affecting the Finnish population. Over the last decade, evidence-based care has emerged to complement other approaches to antihypertensive care, often without health economic assessment of its costs and effects. This study looks at the extent to which changes proposed by the 2002 Finnish evidence-based Current Care Guidelines concerning the prevention, diagnosis, and treatment of hypertension (the ACCG scenario) can be considered cost-effective when compared to modelled prior clinical practice (the PCP scenario).


METHODS
A decision analytic model compares the ACCG and PCP scenarios using information synthesised from a set of national registers covering prescription drug reimbursements, morbidity, and mortality with data from two national surveys concerning health and functional capacity. Statistical methods are used to estimate model parameters from Finnish data. We model the potential impact of the different treatment strategies under the ACCG and PCP scenarios, such as lifestyle counselling and drug therapy, for subgroups stratified by age, gender, and blood pressure. The model provides estimates of the differences in major health-related outcomes in the form of life-years and costs as calculated from a 'public health care system' perspective. Cost-effectiveness analysis results are presented for subgroups and for the target population as a whole.


RESULTS
The impact of the use of the ACCG scenario in subgroups (aged 40-80) without concomitant cardiovascular and related diseases is mainly positive. Generally, costs and life-years decrease in unison in the lowest blood pressure group, while in the highest blood pressure group costs and life-years increase together and in the other groups the ACCG scenario is less expensive and produces more life-years. When the costs and effects for subgroups are combined using standard decision analytic aggregation methods, the ACCG scenario is cost-saving and more effective.


CONCLUSIONS
The ACCG scenario is likely to reduce costs and increase life-years compared to the PCP scenario in many subgroups. If the estimated trade-offs between the subgroups in terms of outcomes and costs are acceptable to decision-makers, then widespread implementation of the ACCG scenario is expected to reduce overall costs and be accompanied by positive outcomes overall.
Booth
Neill
N
Tampere School of Public Health, University of Tampere, Tampere, Finland. neill.booth@uta.fi
Jula
Antti
A
Aronen
Pasi
P
Kaila
Minna
M
Klaukka
Timo
T
Kukkonen-Harjula
Katriina
K
Reunanen
Antti
A
Rissanen
Pekka
P
Sintonen
Harri
H
Mäkelä
Marjukka
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000191:economics / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D003657:Decision Making; D004334:Drug Administration Schedule; D004363:Drug Utilization / Q000191:economics* / Q000592:standards*; D005260:Female; D005387:Finland / Q000453:epidemiology; D019983:Guideline Adherence / Q000191:economics; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000191:economics / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D019057:Quality-Adjusted Life Years; D012042:Registries
D000959:Antihypertensive Agents