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CME – Hypertension: Examining Cost Effectiveness of Treatment

CME – Hypertension: Examining Cost Effectiveness of Treatment
Author Information (click to view)

Andrew E. Moran, MD, MPH

Herbert Irving Assistant Professor of Medicine
Columbia University Medical Center

 

Figure 2 (click to view)
Target Audience (click to view)

This activity is designed to meet the needs of physicians.

Learning Objectives(click to view)

Upon completion of the educational activity, participants should be able to:

  1. Describe the key findings—and their implications—of a study that sought to estimate the incremental health gains and cost-effectiveness of implementing the strongest recommendations for hypertension therapy in the Eighth Joint National Committee’s 2014 guidelines on hypertension among adults.

Method of Participation(click to view)

Statements of credit will be awarded based on the participant reviewing monograph, correctly answer 2 out of 3 questions on the post test, completing and submitting an activity evaluation.  A statement of credit will be available upon completion of an online evaluation/claimed credit form at www.akhcme.com/pwjune4.  You must participate in the entire activity to receive credit.  If you have questions about this CME/CE activity, please contact AKH Inc. at dcotterman@akhcme.com.

Credit Available(click to view)

AKH

CME Credit Provided by AKH Inc., Advancing Knowledge in Healthcare

Physicians
This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of AKH Inc., Advancing Knowledge in Healthcare and Physician’s Weekly’s.  AKH Inc., Advancing Knowledge in Healthcare is accredited by the ACCME to provide continuing medical education for physicians.

 

AKH Inc., Advancing Knowledge in Healthcare designates this enduring activity for a maximum of 0.5 AMA PRA Category 1 Credit(s)™.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Commercial Support(click to view)

There is no commercial support for this activity.

Disclosures(click to view)

It is the policy of AKH Inc. to ensure independence, balance, objectivity, scientific rigor, and integrity in all of its continuing education activities. The author must disclose to the participants any significant relationships with commercial interests whose products or devices may be mentioned in the activity or with the commercial supporter of this continuing education activity. Identified conflicts of interest are resolved by AKH prior to accreditation of the activity and may include any of or combination of the following: attestation to non-commercial content; notification of independent and certified CME/CE expectations; referral to National Author Initiative training; restriction of topic area or content; restriction to discussion of science only; amendment of content to eliminate discussion of device or technique; use of other author for discussion of recommendations; independent review against criteria ensuring evidence support recommendation; moderator review; and peer review.

Disclosure of Unlabeled Use & Investigational Product(click to view)

This educational activity may include discussion of uses of agents that are investigational and/or unapproved by the FDA. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Disclaimer(click to view)

This course is designed solely to provide the healthcare professional with information to assist in his/her practice and professional development and is not to be considered a diagnostic tool to replace professional advice or treatment. The course serves as a general guide to the healthcare professional, and therefore, cannot be considered as giving legal, nursing, medical, or other professional advice in specific cases. AKH Inc. specifically disclaim responsibility for any adverse consequences resulting directly or indirectly from information in the course, for undetected error, or through participant’s misunderstanding of the content.

Faculty & Credentials(click to view)

FACULTY DISCLOSURES

Keith D’Oria, Editorial Director
Discloses no financial relationships with pharmaceutical or medical product manufacturers.
Andrew E. Moran, MD, MPH
Discloses no financial relationships with pharmaceutical or medical product manufacturers.
 
AKH and PHYSICIAN WEEKLY’S STAFF/REVIEWERS

Dorothy Caputo, MA, BSN, RN- CE Director of Accreditation
Discloses no financial relationships with pharmaceutical or medical product manufacturers.

AKH planners and reviewers have no relevant financial relationships to disclose.

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Andrew E. Moran, MD, MPH (click to view)

Andrew E. Moran, MD, MPH

Herbert Irving Assistant Professor of Medicine
Columbia University Medical Center

 

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Implementing hypertension guidelines for adults could help the healthcare system prevent as many as 56,000 cardiovascular events and 13,000 deaths annually while simultaneously saving money on the costs of caring for hypertensive patients.
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According to current estimates, 44% of the 64 million adults in the United States with hypertension did not have their condition controlled in 2014. In 2014, the Eighth Joint National Committee released its first updated guidelines on hypertension since 2003. Several important changes were made from the earlier guideline, including recommendations to focus on diastolic rather than systolic blood pressure (BP) for adults younger than 60 and setting more conservative BP goals for adults aged 60 and older (150/90 mm Hg) as well as for patients with diabetes or chronic kidney disease (140/90 mm Hg).

Estimating Cost Effectiveness

“Few analyses have examined the health benefits and cost-effectiveness of treating hypertension in the U.S.,” says Andrew E. Moran, MD, MPH. To address this research gap, Dr. Moran and colleagues published a study in the New England Journal of Medicine that sought to estimate the incremental health gains and cost-effectiveness of implementing the strongest recommendations for hypertension therapy in the 2014 guidelines among adults.

Using the Cardiovascular Disease Policy Model, the study team simulated drug-treatment and monitoring costs, costs averted for the treatment of cardiovascular disease (CVD), and quality-adjusted life-years gained by treating previously untreated adults between the ages of 35 and 74 from 2014 through 2024. “Our model pulled together data from many studies to quantify the value of treating hypertension,” adds Dr. Moran. “This information is important for policy-makers and physicians to determine if controlling hypertension is a worthwhile investment.”

Hypertension-Cost-Effectiveness-Callout

Big Rewards for Achieving Goals

The study found that, on average, about 860,000 people with existing CVD and hypertension who are not being treated with antihypertensive medications would be eligible for secondary prevention every year from 2014 through 2024. Full implementation of the new hypertension guidelines would result in approximately 56,000 fewer cardiovascular events and 13,000 fewer deaths from cardiovascular causes annually, which in turn would result in overall cost savings (Table).

According to the study projections, treatment of men or women with existing CVD or men with stage 2 hypertension but without CVD would still be cost-saving even if strategies to increase medication adherence doubled treatment costs. The treatment of stage 1 hypertension was cost-effective for all men and women between the ages of 45 and 74 years (Figure). However, treating women between the ages of 35 and 44 years with stage 1 hypertension but without CVD had intermediate or low cost effectiveness.

“Our model predicted that achieving the hypertension treatment goals outlined in the 2014 guidelines would be cost-saving because it will reduce mortality and morbidity from CVD in hypertensive patients who were previously untreated,” Dr. Moran says. “By controlling high blood pressure, we can have a significant impact on improving overall health, while at the same time, saving money.”

Significant Implications

The study results imply that it is important to invest in strategies to reduce the burden of hypertension, including more frequent office visits, home BP monitoring, pharmacist interventions, and sustained efforts to improve adherence. The study notes that these actions may add substantial value, even if they require an additional annual investment of up to $1,230 per patient in men with CVD, $600 in men with stage 2 hypertension without CVD, and $650 in women with CVD.

“We need to focus our efforts on motivating patients to take measures to lower their BP,” Dr. Moran says. “Hypertension is often asymptomatic for years, so it’s important to make sure patients understand that they need to adhere to their medication regimens as prescribed in order to reap the long-term benefits. Taking a team approach—including physicians, nurses, pharmacists, and others—is critical to enhancing the traditional approach to hypertension management. Many patients need a support system in place in order to adhere to their medications.”

Despite the gains that have been made in caring for hypertension, there are still about 28 million adults who have uncontrolled hypertension. “Treating hypertension has become a national priority, but we need more data on how best to manage older patients,” says Dr. Moran. “Our study also suggested that treating women younger than 60 with stage 1 hypertension provided the least value, but this finding might change if our projections accounted for the effects of high BP over several decades. With more research in these areas, there is hope that we can learn more about the value of improving the use of guideline-recommended therapies for hypertension.”

Readings & Resources (click to view)

Moran AE, Odden MC, Thanataveerat A, et al. Cost-effectiveness of hypertension therapy according to 2014 guidelines. N Engl J Med. 2015;372:447-455. Available at: http://www.nejm.org/doi/full/10.1056/NEJMsa1406751#t=article.

Navar-Boggan AM, Pencina MJ, Williams K, Sniderman AD, Peterson ED. Proportion of US adults potentially affected by the 2014 hypertension guideline. JAMA. 2014;311:1424-1429.

James PA, Oparil S, Carter BL, et al. 2014 Evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014;311:507-520.

Go AS, Bauman MA, Coleman King SM, et al. An effective approach to high blood pressure control: a science advisory from the American Heart Association, the American College of Cardiology, and the Centers for Disease Control and Prevention. Hypertension. 2014;63:878-885.

Cutler DM, Long G, Berndt ER, et al. The value of antihypertensive drugs: a perspective on medical innovation. Health Aff (Millwood). 2007;26:97-110.

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