Hypertension and common complications --analysis of the ambulatory treatment cost.
OBJECTIVE
Retrospective analysis of the prescribing practice and cost of ambulatory treatment of hypertension and its common complications--heart failure, sequelae of cerebrovascular disease, and angina pectoris.


METHODS
Analysis of 3,240 reimbursable ambulatory prescriptions for hypertension, heart failure, sequelae of cerebrovascular disease and angina pectoris according to the complexity of the therapy and frequency of the prescribed medicines. Modeling and calculation of the expected monthly cost for outpatient therapy by using the "decision tree model". Sensitivity analysis is performed within the +/- 30% interval.


RESULTS
65% of the prescription were for the hypertension, and 35% for the observed complications. 1,297 prescriptions for hypertension include one medicine, 647 include two medicines, and only 8% of prescriptions were for three medicines. ACE inhibitors have been prescribed in 41% of all hypertension prescriptions, followed by beta-blockers (19%), Ca channel blockers (16%), diuretics (15%) etc. The prescriptions for hypertension complications are more diverse as therapeutic groups. The expected monthly cost of prescribed medicines per patient with hypertension alone is 6.90 Euro and in case of complications it is 10.71 Euro according to the prevalence of the complexity of therapy, and weighted monthly cost of medicines. The overall ambulatory cost is expected to be around 148 million Euro per year for near 1.5 million patients with 44% reimbursement. The cost of the therapy is sensitive more to changes in the medicine's prices than to its complexity.


CONCLUSIONS
This study is a first step in providing information for evidence-based cost containment measures or policy decisions at ambulatory level in Bulgaria and for the assessment of the share of complications' therapy on the overall hypertension cost.
Ivanova
Anna D
AD
Department of Social Pharmacy, Faculty of Pharmacy, Medical University, Sofia, Bulgaria. an5dar@yahoo.co.uk
Petrova
Guenka I
GI
D000553:Ambulatory Care / Q000191:economics*; D000787:Angina Pectoris / Q000188:drug therapy / Q000191:economics; D000959:Antihypertensive Agents / Q000191:economics* / Q000627:therapeutic use*; D002317:Cardiovascular Agents / Q000191:economics / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000188:drug therapy / Q000191:economics*; D003663:Decision Trees; D004359:Drug Therapy, Combination; D004363:Drug Utilization; D006333:Heart Failure / Q000188:drug therapy / Q000191:economics; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000191:economics*; D010818:Practice Patterns, Physicians' / Q000191:economics; D011306:Prescription Fees; D012189:Retrospective Studies
D000959:Antihypertensive Agents; D002317:Cardiovascular Agents