A national hypertension treatment program in Germany and its estimated impact on costs, life expectancy, and cost-effectiveness

Gandjour, Afschin; Stock, Stephanie

doi:10.1016/j.healthpol.2007.01.003

Cited by 30 publications

(71 citation statements)

References 36 publications

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“…the differences between treatments are small, except in the case of ca channel blockers, compared to other antihypertensive therapies. the results of our study are in agreement with results from the pharmacoeconomic study conducted in Germany (16) and Spain (35). From the perspective of the national health insurance funds, antihypertensive treatment prolongs patients' life and affects patients' quality of life with relatively modest increase in the health care expenditure compared to "no intervention".…”

Section: Cost-effectiveness Analysissupporting

confidence: 89%

“…Due to the lack of adequate studies, we conducted a sensitivity analysis. it was performed on a cohort of patients aged 55. the obtained results should not be extrapolated to younger or to older patients, since several pharmacoeconomic studies have shown that ICER values (regardless of strategy) are significantly higher in younger patients, and significantly lower in older patients when compared with the patients chosen as subjects in the analyzed cohort (16,35,39,41).…”

Section: Cost-effectiveness Analysismentioning

confidence: 99%

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The Cost-Effectiveness of Hypertension Pharmacotherapy in Serbia: A Markov Model

Lakic

Petrova

Bogavac-Stanojević

et al. 2012

Biotechnology & Biotechnological Equipment

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Section: Cost-effectiveness Analysissupporting

confidence: 89%

Section: Cost-effectiveness Analysismentioning

confidence: 99%

The Cost-Effectiveness of Hypertension Pharmacotherapy in Serbia: A Markov Model

Lakic

Petrova

Bogavac-Stanojević

et al. 2012

Biotechnology & Biotechnological Equipment

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“…However, even assuming the long-term sustainability of such an intervention it is unlikely that it will change conclusions: lifestyle interventions may not be cheaper than drug treatment (Pickering, 2003) and are able to substitute drug treatment only in patients with mild hypertension (Appel et al, 2003). Final limitations concern the Markov model and the simulation of the long-term costs and effects of antihypertensives and are addressed in the reference paper (Gandjour and Stock, 2007).…”

Section: Discussionmentioning

confidence: 99%

“…Long-term costs and effects of reducing underuse. Recently, we published a Markov decision model to analyze the long-term cost and effect of lifelong hypertension treatment compared to no treatment (Gandjour and Stock, 2007). In brief, our model contains the following five health states: no cardiovascular disease, myocardial infarction (MI), stroke (including transient ischemia), renal failure, and death.…”

Section: Predicting the Costs And Cost-effectiveness Of Dm For Hypertmentioning

confidence: 99%

A model to predict the cost‐effectiveness of disease management programs

Gandjour

2009

Health Economics

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High costs and deficits in the care of patients with chronic diseases have triggered numerous programs to improve the quality and efficiency of treatment of chronic diseases. Decision makers need to estimate the impact of a disease management program (DMP) on long-term costs and cost-effectiveness in order to decide which programs to introduce. This prediction, however, requires formalizing the relations between a variety of variables. The purpose of this paper is to formalize these relations and develop a model that enhances the quality of predictions of the costs and cost-effectiveness of a DMP. The model's cost function is able to portray a reduction both of treatment overuse and underuse by improving both physician and patient compliance. The model's applicability is demonstrated by a simulated DMP for patients with hypertension. The application example shows that implementation costs may have a larger financial impact than downstream costs.

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“…Therefore, from the reading it is not clear how the authors came up with their finding of savings from adherence improvement. This result is also at odds with the results of cost-effectiveness analyses on BP treatment conducted in England and Germany using the Framingham risk equation as well: they did not show savings except for the treatment of high-risk patients [2,3].…”

mentioning

confidence: 90%

Commentary to: Cost of poor adherence to anti-hypertensive therapy in five European countries

Gandjour

2015

Eur J Health Econ

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The study by Mennini et al.[1] uses a decision model to assess cost implications of improving adherence to medication in hypertensive patients in five European countries (England, France, Germany, Italy, and Spain) from a payer's perspective over 10 years. To this end, the model predicts the 10-year risk for cardiovascular events based on the Framingham risk equation. In terms of costs, it considers drug and hospitalization costs. The model suggests savings through avoiding cardiovascular events in each of the five countries.Leaving aside a lack of consideration of costs of (a) medication side effects, (b) outpatient care, (c) rehabilitation, and (d) life extension, this result cannot be replicated based on the input data listed in the publication. This points to a potential lack of internal validity. To explain, consider that the net cost of making one additional patient adherent to blood pressure (BP) medication can be calculated in two steps:1. Absolute risk reduction of BP treatment = (probability of BP controljBP treatment) 9 (absolute risk reductionjBP control) 2. Net cost = 10-year cost of BP treatment -(absolute risk reduction of BP treatment) 9 (cost of hospitalization), where absolute risk reduction (ARR) refers to cardiovascular events. With regard to the first equation, Table 1 provides data on the ARR of BP control. In Italy, for example, a favorable estimate for the ARR of BP control is 5.5 % (=10-4.5 %), which holds for females. In addition, based on data in Appendix C, 56.7 % of Italian patients treated are controlled. Hence, the ARR of BP treatment is 3.1 % (5.5 9 56.7 %). Inserting this value in the second equation yields the net cost: 10 9 €280-0.031 9 €3939 = €2677.16. Hence, BP treatment in Italy leads to a net increase in costs. We obtain the same result for the other countries. Therefore, from the reading it is not clear how the authors came up with their finding of savings from adherence improvement. This result is also at odds with the results of cost-effectiveness analyses on BP treatment conducted in England and Germany using the Framingham risk equation as well: they did not show savings except for the treatment of high-risk patients [2, 3]. References

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A national hypertension treatment program in Germany and its estimated impact on costs, life expectancy, and cost-effectiveness

Cited by 30 publications

References 36 publications

The Cost-Effectiveness of Hypertension Pharmacotherapy in Serbia: A Markov Model

The Cost-Effectiveness of Hypertension Pharmacotherapy in Serbia: A Markov Model

A model to predict the cost‐effectiveness of disease management programs

Commentary to: Cost of poor adherence to anti-hypertensive therapy in five European countries

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