Epidemiological and economic burden of metabolic syndrome and its consequences in patients with hypertension in Germany, Spain and Italy; a prevalence-based model.
BACKGROUND
The presence of metabolic syndrome in patients with hypertension significantly increases the risk of cardiovascular disease, type 2 diabetes and mortality. Our aim is to estimate the epidemiological and economic burden to the health service of metabolic syndrome in patients with hypertension in three European countries in 2008 and 2020.


METHODS
An age, sex and risk group structured prevalence based cost of illness model was developed using the United States Adult Treatment Panel III of the National Cholesterol Education Program criteria to define metabolic syndrome. Data sources included published information and public use databases on disease prevalence, incidence of cardiovascular events, prevalence of type 2 diabetes, treatment patterns and cost of management in Germany, Spain and Italy.


RESULTS
The prevalence of hypertension with metabolic syndrome in the general population of Germany, Spain and Italy was 36%, 11% and 10% respectively. In subjects with hypertension 61%, 22% and 21% also had metabolic syndrome. Incident cardiovascular events and attributable mortality were around two fold higher in subjects with metabolic syndrome and prevalence of type 2 diabetes was around six-fold higher. The economic burden to the health service of metabolic syndrome in patients with hypertension was been estimated at €24,427, €1,900 and €4,877 million in Germany, Spain and Italy and forecast to rise by 59%, 179% and 157% respectively by 2020. The largest components of costs included the management of prevalent type 2 diabetes and incident cardiovascular events. Mean annual costs per hypertensive patient were around three-fold higher in subjects with metabolic syndrome compared to those without and rose incrementally with the additional number of metabolic syndrome components present.


CONCLUSIONS
The presence of metabolic syndrome in patients with hypertension significantly inflates economic burden and costs are likely to increase in the future due to an aging population and an increase in the prevalence of components of metabolic syndrome.
Scholze
Jürgen
J
Department of Medicine, Outpatient Clinic, CCM, Charite-Universitatsmedizin Berlin, Luisenstrasse 11-13, 10117 Berlin, Germany. juergen.scholze@charite.de
Alegria
Eduardo
E
Ferri
Claudio
C
Langham
Sue
S
Stevens
Warren
W
Jeffries
David
D
Uhl-Hochgraeber
Kerstin
K
D015897:Comorbidity; D017281:Cost of Illness; D003365:Costs and Cost Analysis; D005060:Europe / Q000453:epidemiology; D005260:Female; D006306:Health Surveys; D006801:Humans; D006973:Hypertension / Q000453:epidemiology*; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications / Q000191:economics* / Q000453:epidemiology*; D008962:Models, Theoretical; D015995:Prevalence
Diabetes Care. 2005 Jul;28(7):1769-78
15983333
Health Policy. 2007 Oct;83(2-3):257-67
17335933
Diabetologia. 2002 Jul;45(7):S5-12
12136405
Blood Press. 2007;16(6):347-53
18058454
Am J Cardiol. 2007 Feb 15;99(4):541-8
17293200
Am J Med. 2006 Oct;119(10):812-9
17000207
Hypertension. 2006 May;47(5):881-6
16585414
J Hypertens. 2006 May;24(5):837-43
16612244
J Cardiometab Syndr. 2007 Winter;2(1):9-15
17684454
Circulation. 2007 Apr 17;115(15):1991-8
17404163
J Hypertens. 2009 Mar;27(3):441-51
19262221
J Hypertens. 2008 Oct;26(10):1891-900
18806611
Am J Hypertens. 2006 Feb;19(2):189-96; discussion 197-8
16448891
Atherosclerosis. 2008 Mar;197(1):147-53
17466306
Curr Med Res Opin. 2007 Mar;23(3):495-503
17355731
Circulation. 2002 Dec 17;106(25):3143-421
12485966
BMC Public Health. 2008 Jun 05;8:200
18533989
Am J Hypertens. 2007 May;20(5):558-64
17485022
Blood Press. 2009;18(6):308-47
20001654
Blood Press. 2007;16(1):20-7
17453748
Eur J Health Econ. 2011 Jun;12(3):205-18
20405160
J Hum Hypertens. 2007 Oct;21(10):795-801
17508012
Lancet. 2007 Jan 20;369(9557):201-7
17240286
Circulation. 1998 Oct 6;98(14):1472-6
9841132
Diabetes Care. 1993 Feb;16(2):434-44
8432214
Med Clin (Barc). 2006 Mar 25;126(11):406-9
16595083
J Hypertens. 1998 Aug;16(8):1103-12
9794712
Diabetes Care. 2001 Apr;24(4):683-9
11315831
BMJ. 2006 Nov 25;333(7578):1081
17114210
Pharmacoeconomics. 2004;22(15):1001-14
15449964
BMJ. 2009 May 19;338:b1665
19454737
J Hum Hypertens. 1992 Dec;6(6):481-3
1296013
Int J Clin Pharmacol Ther. 2010 Mar;48(3):173-83
20197011
JAMA. 2003 May 21;289(19):2560-72
12748199
Eur Heart J. 2007 Jun;28(12):1462-536
17562668
J Hypertens. 2004 Jan;22(1):51-7
15106794
J Hypertens. 2008 Apr;26(4):819-24
18327094
Ann Rheum Dis. 2004 Apr;63(4):395-401
15020333
Hypertension. 2007 Jan;49(1):40-7
17130308
Blood Press. 2002;11(1):35-45
11926349
Am J Hypertens. 2007 Dec;20(12):1291-6
18047919
J Hypertens. 2001 Jan;19(1):149-55
11204296
J Hum Hypertens. 2001 May;15(5):329-34
11378835
Am J Med. 2006 May;119(5 Suppl 1):S24-30
16563944
Curr Med Res Opin. 2008 Jan;24(1):121-7
18031596
J Clin Hypertens (Greenwich). 2007 Aug;9(8):595-600
17673880
J Hypertens. 2008 Oct;26(10):2064-70
18806632
J Clin Hypertens (Greenwich). 2004 Feb;6(2):76-84
14872145
J Am Coll Cardiol. 2004 May 19;43(10):1817-22
15145106
Circulation. 2003 Jul 29;108(4):414-9
12860911
Lancet. 2008 May 3;371(9623):1513-8
18456100
J Hum Hypertens. 2007 May;21(5):366-73
17301825