title: Cost implications of improving blood pressure management among U.S. adults.
abstract: OBJECTIVE
  To examine the cost-effectiveness of improving blood pressure management from the payer perspective.
  
  
  METHODS
  Medical record data for 4,500 U.S. adults with hypertension from the Community Quality Index (CQI) study (1996-2002), pharmaceutical claims from four Massachusetts health plans (2004-2006), Medicare fee schedule (2009), and published literature.
  
  
  METHODS
  A probability tree depicted blood pressure management over 2 years.
  
  
  METHODS
  We determined how frequently CQI study subjects received recommended care processes and attained accepted treatment goals, estimated utilization of visits and medications associated with recommended care, assigned costs based on utilization, and then modeled how hospitalization rates, costs, and goal attainment would change if all recommended care was provided.
  
  
  RESULTS
  Relative to current care, improved care would cost payers U.S.$170 more per hypertensive person annually (2009 dollars). The incremental cost per person newly attaining treatment goals over 2 years would be U.S.$1,696 overall, U.S.$801 for moderate hypertension, and U.S.$850 for severe hypertension. Among people with severe hypertension, blood pressure would decline substantially but seldom reach goal; the incremental cost per person attaining a relaxed goal (≤ stage 1) would be U.S.$185.
  
  
  CONCLUSIONS
  Under the Health Care Effectiveness Data and Information Set program, which monitors the attainment of blood pressure treatment goals, payers will find it slightly more cost-effective to improve care for moderate than severe hypertension. Having a secondary, relaxed goal would substantially increase payers' incentive to improve care for severe hypertension.
authors.affiliation: RAND Corporation, 1776 Main Street, Santa Monica, CA 90407, USA. teryl@rand.org
authors.forename: Teryl K
authors.initials: TK
authors.lastname: Nuckols
authors.forename: Julia E
authors.initials: JE
authors.lastname: Aledort
authors.forename: John
authors.initials: J
authors.lastname: Adams
authors.forename: Julie
authors.initials: J
authors.lastname: Lai
authors.forename: Myong-Hyun
authors.initials: MH
authors.lastname: Go
authors.forename: Joan
authors.initials: J
authors.lastname: Keesey
authors.forename: Elizabeth
authors.initials: E
authors.lastname: McGlynn
mesh_terms: D000959:Antihypertensive Agents / Q000191:economics / Q000627:therapeutic use*; D001794:Blood Pressure; D003362:Cost-Benefit Analysis; D003376:Counseling / Q000191:economics; D004363:Drug Utilization; D006296:Health Services / Q000706:statistics & numerical data*; D006801:Humans; D006973:Hypertension / Q000191:economics* / Q000628:therapy*; D008019:Life Style; D018803:Models, Economic; D009819:Office Visits / Q000706:statistics & numerical data*; D011787:Quality of Health Care / Q000706:statistics & numerical data; D012720:Severity of Illness Index
chemical_list: D000959:Antihypertensive Agents