Hypertension Costs: Source, Evolution and Impact of Cost-Containment Measures in Various Health-Care Systems

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Abstract
As a consequence of the high prevalence of hypertension in most countries, the management of this disease generates costs which are only justified if the beneficial effects of the reduced blood pressure can be achieved by the long-term control of blood pressure in compliant patients. The expenditure includes not only the cost of drugs, but also the cost of visits to physicians and various supplementary examinations. Whereas these latter cost items are exclusively dependent on the physicians who order them, the costs of the drugs are dependent on the physician's choice and also on the drug-pricing mechanisms, which are complex, variable from one country to another and dependent on economic choices, as well as on medical parameters. The selection of drugs should be tailored to each individual patient and based on reliable medical evidence. However, the consequences of the choice of drugs will be very much influenced by the pricing procedures applied in each country. Whereas improvement in the quality of hypertension management will increase the efficacy of the medical intervention, cost-containment measures might make it even more efficient. These measures can be initiated by the physicians themselves, in regard to the number of visits and the choice of supplementary examinations. They can also be generated by incentive measures coming from the different health-care systems (state or private insurance schemes). Such measures should prevent patients being deprived of access to the most modern methods of treatment, including examinations and drugs, while at the same time aiming at eliminating unnecessary examinations and inappropriate choice of drugs. The impact of cost-containment measures, when implemented, should be monitored in regard to both the quality of care (permanent blood pressure control of treated patients, without impairment of their quality of life) and the existence of social inequalities in the access to optimal health-care.