The value of antihypertensive drugs: A perspective on medical innovation

Health Affairs

Volumn 26, Issue 1, 2007, Pages 97-110

  Cutler, David M ^a   Long, Genia ^b   Berndt, Ernst R ^c   Royer, Jimmy ^d   Fournier, Andrée Anne ^d   Sasser, Alicia ^e   Cremieux, Pierre ^b  

^a HARVARD UNIVERSITY   (United States)

^b ANALYSIS GROUP   (United States)

^c MASSACHUSETTS INSTITUTE OF TECHNOLOGY   (United States)

^d GROUPE D ANALYSE   (Canada)

^e FEDERAL RESERVE BANK OF BOSTON   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ANTIHYPERTENSIVE AGENT;

ADULT; AGED; BLOOD PRESSURE; CEREBROVASCULAR ACCIDENT; COMPARATIVE STUDY; COST BENEFIT ANALYSIS; COST OF ILLNESS; DRUG EFFECT; ECONOMICS; EXPERIMENTAL THERAPY; FEMALE; HEART INFARCTION; HUMAN; HYPERTENSION; MALE; MASS COMMUNICATION; MIDDLE AGED; REVIEW; RISK FACTOR; UNITED STATES;

ADULT; AGED; ANTIHYPERTENSIVE AGENTS; BLOOD PRESSURE; CEREBROVASCULAR ACCIDENT; COST OF ILLNESS; COST-BENEFIT ANALYSIS; DIFFUSION OF INNOVATION; FEMALE; HUMANS; HYPERTENSION; MALE; MIDDLE AGED; MYOCARDIAL INFARCTION; RISK FACTORS; THERAPIES, INVESTIGATIONAL; UNITED STATES;

EID: 33846651266     PISSN: 02782715     EISSN: 02782715     Source Type: Journal    
DOI: 10.1377/hlthaff.26.1.97     Document Type: Review

References (46)

1. D.M. Cutler and M. McClellan, "Is Technological Change in Medicine Worth It?" Health Affairs 20, no. 5 (2001): 11-29.
2. See, for instance, ibid.;
3. D.M. Cutler and E. Meara, "The Technology of Birth: Is It Worth It?" in Frontiers in Health Policy Research, vol. 3, ed. A. Garber (Cambridge, Mass.: MIT Press, 2000), 33-67;
4. E.R. Berndt et al., "The Medical Treatment of Depression, 1991-1996: Productive Inefficiency, Expected Outcome Variations, and Price Indexes," Journal of Health Economics 21, no. 3 (2002): 373-396;
5. I. Shapiro, M.D. Shapiro, and D.W. Wilcox, "Measuring the Value of Cataract Surgery," in Medical Care Output and Productivity, ed. D.M. Cutler and E.R. Berndt (Chicago: University of Chicago Press, 2001);
6. and D.M. Cutler and M. McClellan, "The Productivity of Cancer Care" (Unpublished paper, Harvard University, 2001).
7. Authors' calculations from 1999-2000 National Health and Nutrition Examination Survey (NHANES) data.
8. R.S. Vasan et al., "Residual Lifetime Risk for Developing Hypertension in Middle-Aged Women and Men: The Framingham Heart Study," Journal of the American Medical Association 287, no. 8 (2002): 1003-1010.
9. Figures derived by authors by applying established methodologies of Rice and colleagues and of Hodgson and Cohen to 2002 data. See D.P. Rice, T.A. Hodgson, and A.N. Kopstein, "The Economic Costs of Illness: A Replication and Update, "Health Care Financing Review 7, no. 1 (1985): 61-80;
10. and T.A. Hodgson and A.J. Cohen, "Medical Care Expenditures for Selected Circulatory Diseases: Opportunities for Reducing National Health Expenditures," Medical Care 37, no. 10 (1999): 994-1012.
11. D.M. Cutler, Your Money or Your Life (New York: Oxford University Press, 2004),
12. citing H. Bruenn, "Clinical Notes on the Illness and Death of President Franklin D. Roosevelt," Annals of Internal Medicine 72, no. 4 (1970): 591.
13. D.M. Cutler and S. Kadiyala, "The Return to Biomedical Research: Treatment and Behavioral Effects," in Measuring the Gains from Medical Research, ed. K.M. Murphy and R.H. Topel (Chicago: University of Chicago Press, 2001), 110-162.
14. Harrison's Principles of Internal Medicine (New York: McGraw-Hill, 1962), 1346.
15. To allow for nonlinearities, an alternative specification was tested with the continuous BMI variables in the BP equation replaced by six categories from the literature: "less than or within normal BMI range," "marginally overweight," "overweight," "very overweight," "severely obese," and "morbidly/super obese," from K. Renquist, "Obesity Classification," Obesity Surgery 7, no. 6 (1997): 523. The relationship between BP and BMI was found to be linear for women and weakly concave for men.
16. More detail can be found in an online Technical Appendix, at http://content.healthaffairs.org/cgi/content/full/26/1/97/DC1.
17. 2 measure increasing only at the third decimal point. Results were essentially unaffected when the dependent variable was log-transformed.
18. "The Fifth Report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure (JNC V)," Archives of Internal Medicine 153, no. 2 (1993): 154-183. JNC V BP categories were used in the risk equations of Peter Wilson and colleagues; see Note 15.
19. D.C. Goff et al., "Birth Cohort Evidence of Population Influences on Blood Pressure in the United States, 1887-1994," Annals of Epidemiology 11, no. 4 (2001): 271-279.
20. Details are available in the online Technical Appendix; see Note 10.
21. P.W. Wilson et al., "Prediction of Coronary Heart Disease using Risk Factor Categories," Circulation 97, no. 18 (1998): 1837-1847,
22. based on National Center for Health Statistics, "United States Life Tables, 2001," National Vital Statistics Reports 52, no. 14 (2001);
23. and NCHS, "Deaths: Final Data for 2001," National Vital Statistics Reports 52, no. 3 (2001).
24. K.M. Anderson et al., "Cardiovascular Disease Risk Profiles," American Heart Journal 121, no. 1, Part 2 (1991): 293-298. Anderson and colleagues' risk equations are generated from separate parametric models predicting the probability of stroke and MI for men and women of given characteristics (age, BP, smoking, ratio of total cholesterol to HDL-C, diabetes, and ECG-LVH) over the next four to twelve years.
25. The risks of death from cardiovascular disease, stroke, and MI increase more than proportionally with BP. Therefore, for any sex-age cohort, risk is higher for people with higher BP. In estimating avoided deaths resulting from better-controlled BP, we calculated relative risks for each sample observation and averaged them for the total sex-age cohort according to their sample weights. This average relative risk is multiplied by the observed number of deaths for that cohort and the number of avoided deaths calculated. But it is likely that those with CVD have higher BPs than others in their sex-age cohort. If so, deaths would increase by more than the average relative risk, and we would have underestimated the number of avoided deaths resulting from better-controlled BP. The same logic applies to avoided strokes and MI.
26. W.L. May and W.D. Johnson, "A SAS Macro for Constructing Simultaneous Confidence Intervals for Multinomial Proportions," Computer Methods and Programs in Biomedicine 53, no. 3 (1997): 153-162.
27. Additional details are provided in the online Technical Appendix; see Note 10.
28. NCHS, "Deaths: Final Data for 1999," National Vital Statistics Reports 49, no. 8 (1999).
29. A.V. Chobanian et al., "Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure," Hypertension 42, no. 6 (2003): 1206-1252.
30. L.T. Kohn, J.M. Corrigan, and M.S. Donaldson, eds., To Err Is Human: Building a Safer Health System (Washington: National Academies Press, 1999).
31. For summaries, see Chobanian et al., "Seventh Report"; and V. Franco, S. Oparil, and O.A. Carretero, "Hypertensive Therapy: Part II," Circulation 109, no. 25 (2004): 3081-3088.
32. Cutler, Your Money or Your Life.
33. Figures derived from T. Hodgson and L. Cai, "Medical Care Expenditures for Hypertension, Its Complications, and Its Comorbidities," Medical Care 39, no. 6 (2001): 599-615. Per capita average spending for prescription drugs for hypertension by age and sex was applied to average life expectancy, assuming that spending for those under age sixty-five occurs evenly between ages forty and sixty-four, discounted at 3 percent.
34. M. Weinstein, Spending Health Care Dollars Wisely: Can Cost-Effectiveness Analysis Help? Sixteenth Annual Herbert Lourie Memorial Lecture on Health Policy (Syracuse University), Policy Brief no. 30/2005, 5, http://www-cpr.maxwell.syr.edu/pbriefs/pb30.pdf (accessed 3 November 2006).
35. T.A. Hodgson and A.J. Cohen, "National Health Expenditure Amounts, and Average Annual Change, by Type of Expenditure; Selected Calendar Years, 1990-2013," http://www.cms.hhs.gov/NationalHealthExpendData/downloads/ proj2005.pdf (accessed 5 October 2006);
36. and T.N. Taylor et al., "Lifetime Cost of Stroke in the United States," Stroke 27, no. 9 (1996): 1459-1466.
37. Hodgson and Cai, "Medical Care Expenditures."
38. Chobanian et al., "Seventh Report."
39. NCHS, "Deaths: Injuries, 2001," National Vital Statistics Reports 52, no. 21 (2001).
40. Cutler, Your Money or Your Life,
41. citing J.Z. Ayanian et al., "Unmet Health Needs of Uninsured Adults in the United States," Journal of the American Medical Association 284, no. 16 (2000): 2061-2069;
42. C. Huttin, J.F. Moeller, and R.S. Stafford, "Patterns and Costs for Hypertension Treatment in the United States," Clinical Drug Investigation 20, no. 3 (2000): 181-195;
43. C. Fish-Parcham, Getting Less Care: The Uninsured with Chronic Health Conditions (Washington: Families USA Foundation, 2001);
44. J.P. Newhouse and the Insurance Experiment Group, Free for All: Lessons from the RAND Health Insurance Experiment (Cambridge, Mass.: Harvard University Press, 1993);
45. and N. Lurie et al., "Termination from Medi-Cal: Does It Affect Health?" New England Journal of Medicine 311, no. 7 (1984): 480-484.
46. A.B. Rosen, "Indications for and Utilization of ACE Inhibitors in Older Individuals with Diabetes: Findings from the National Health and Nutrition Examination Survey 1999 to 2002," Journal of General Internal Medicine 21, no. 4 (2006): 315-319.