Cost-Effectiveness of Recommendations From the Surgeon General’s Call-to-Action to Control Hypertension

Abstract

In response to high prevalence of hypertension and suboptimal rates of blood pressure (BP) control in the US, the Surgeon General released a Call-to-Action to Control Hypertension (Call-to-Action) in the fall of 2020 to address the negative consequences of uncontrolled BP. In addition to morbidity and mortality associated with hypertension, hypertension has an annual cost to the US healthcare system of $71 billion. The Call-to-Action makes recommendations for improving BP control, and the purpose of this review was to summarize the literature on the cost-effectiveness of these strategies. We identified a number of studies that demonstrate the cost saving or cost-effectiveness of recommendations in the Call-to-Action including strategies to promote access to and availability of physical activity opportunities and healthy food options within communities, advance the use of standardized treatment approaches and guideline-recommended care, to promote the use of health care teams to manage hypertension, and to empower and equip patients to use self-measured blood pressure monitoring and medication adherence strategies. While the current review identified numerous cost-effective methods to achieve the Surgeon General’s recommendations for improving BP control, future work should determine the cost-effectiveness of the 2017 American College of Cardiology and American Heart Association Hypertension guidelines, interventions to lower therapeutic inertia, and optimal team-based care strategies, among other areas of research. Economic evaluation studies should also be prioritized to generate more comprehensive data on how to provide efficient and high value care to improve BP control.

Antihypertensive medication persistence and adherence among non-Hispanic Asian US patients with hypertension and fee-for-service Medicare health insurance

“…In the current study, patients who had a Medicare Part D coverage gap were less likely to have non-persistence or low adherence, indicating these patients were taking their antihypertensive medications. However, drug costs are an issue for many patients with hypertension [ 33 , 34 ]. Eliminating the Part D coverage gap and providing continuous pharmacy coverage to patients with hypertension may result in improved persistence and medication adherence.…”

Implementation Strategies to Improve Blood Pressure Control in the United States: A Scientific Statement From the American Heart Association and American Medical Association

“…107,108 Providing medications and devices is often cost neutral or cost saving for insurers because they are preventing the high cost of later complications and hospitalizations. 41,109 Because antihypertensive medication adherence can be improved by simplifying medication regimens and refill synchronization, ideal antihypertensive medication coverage would support these prescribing and dispensing methods. 110 Financial incentives as part of QI efforts have been shown to improve BP control 97,99 and are currently used in many value-based payment models.…”

Barriers and Facilitators of Medication Adherence in Hypertension Patients: A Meta-Integration of Qualitative Research

“… 2 Countries spend huge amounts of money on their healthcare systems every year to combat the negative effects of HTN. 3 Controlling HTN is now a huge challenge for public health systems worldwide.…”