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Improvements in Prescribing Medications for Elderly Patients with High Blood Pressure ...

Could Result in Better Outcomes and Cost Savings

CHICAGO
- Adherence to evidence-based prescribing guidelines for hypertension (high blood pressure) could result in substantial savings in prescription costs for elderly patients, and up to $1.2 billion nationally,
according to a study in the April 21 issue of The Journal of the American Medical Association (JAMA).

"More than 60 percent of Americans aged 65 years and older have hypertension," the authors provide as background information in the article.
"Estimates of the cost of its treatment have ranged from $7 billion to $15.5 billion per year." The authors also note that costs of medications for chronic conditions continue to escalate, particularly for the elderly and
that the proportion of seniors without insurance coverage has increased in recent years, as well.

Michael A. Fischer, M.D., M.S., and Jerry Avorn, M.D., from Brigham and Women's Hospital, Harvard Medical School, Boston, analyzed medication use
patterns in 133,624 hypertensive patients in a state drug assistance program for elderly patients in Pennsylvania during 2001. The researchers "evaluated every antihypertensive regimen in light of the clinical history
of each patient and then estimated the potential cost savings to the health care delivery system that could have been realized through adherence to
evidence-based recommendations."

"The patients studied filled more than 2.05 million prescriptions for antihypertensive medications in 2001, at an annual program cost of $48.5 million ($363 per patient)," the researchers found. "We identified 815,316
prescriptions (40 percent) for which an alternative regimen appeared more appropriate according to evidence-based recommendations. Such changes would have reduced the costs to payers in 2001 by $11.6 million (nearly a quarter
of program spending on antihypertensive medications), as well as being more clinically appropriate overall."

The researchers found that "calcium channel blockers had the highest average cost ($33.39 per prescription) and the highest total spending ($17 million); ACE inhibitors were the second costliest class ($10.5 million). Beta-blockers were the most commonly prescribed antihypertensive drug, but average cost ($15.62) and total spending ($8 million) were lower than for ACE inhibitors or calcium channel blockers. Thiazides (diuretics) were among the least expensive medications ($5.33 per prescription) but accounted for only 4.3 percent of prescriptions."

"Adherence to evidence-based prescribing guidelines for hypertension could result in substantial savings in prescription costs for elderly patients with hypertension that would amount to savings of about $1.2 billion
annually," the authors suggest. "Identification of similar areas in which prescribing can be improved will be critical for the affordability of
prescription drug benefit programs," they conclude.

(JAMA. 2004;291:1850-1856. Available at www.JAMA.com)

Editor's Note: This work was supported in part by a grant from the National
Institute on Aging.

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