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Patterns and Costs for Hypertension Treatment in the United States

Clinical, Lifestyle and Socioeconomic Predictors from the 1987 National Medical Expenditures Survey

  • Clinical Pharmacoeconomics
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Abstract

Objective: To estimate the impact of clinical and non-clinical predictors of patterns of medication use and expenditures for the treatment of hypertension in the USA.

Data Sources: The 1987 National Medical Expenditures Survey was used to identify 6398 individuals with hypertension over the age of 18 years. Pharmacological treatment was identified through patient self-reports of antihypertensive medications.

Study Design: This retrospective, cross-sectional study used a multivariate two-stage decision model to estimate the demand for antihypertensive medications conditional on receipt of at least one antihypertensive prescription drug.

Results: Women and the elderly were more likely to obtain medications and had greater expenditures on antihypertensive medications. Privately insured patients were 59% (if non-elderly) or 163% (if elderly with Medicare) more likely to receive drug therapy than uninsured patients. Patients with only Medicaid coverage were 126% more likely to receive drug therapy than uninsured patients.Compared with patients characterised as lower risk-takers, very high and high risk-takers were 38% and 24% less likely to be on drug therapy, respectively. Black, non-Hispanics were 30% more likely to be on drug therapy than White, non-Hispanics, but had lower annual expenditures on antihypertensive drugs. Severely overweight individuals [bodymass index (BMI) >30] were 62% more likely than patients with a BMI <27 to be on drug therapy and also had higher drug expenditures.

Conclusions: Insurance had a more striking effect on access to antihypertensive drug therapy than on patterns of drug use or expenditures. Race/ethnicity and patient attitudes towards risk were important determinants of access to antihypertensive drug therapies, as well as patterns of drug use and expenditures.

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Notes

  1. 1The Anatomical Therapeutic Classification is a system of drug classification developed by the Scandinavian countries and adopted by WHO (for further information on the classification, the reader can consult WHO website at http://www.whocc.nmd.no).

  2. 2CHAMPUS is a programme that covers the medical expenses of dependents of active-duty personnel in the US military.

  3. 3Coefficient of determination.

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Acknowledgements

The research was partly supported by a research grant from the Agency for Healthcare Research and Quality (AHRQ) [R03 HS09538]. We also gratefully acknowledge the assistance of Jane Faulman of Social and Scientific Systems for data processing services in constructing the data base for the study, and the Harvard School of Public Health, in particular Dr Alec Walker for advice on pharmacoepidemiology, and Sidney Atwood for technical computer assistance. We also thank Steven Cohen, Alan Monheit and John Fleishman for helpful comments on an earlier draft of this paper. The views expressed in this paper are those of the authors and do not represent the views or policies of either the AHRQ or the US Department of Health and Human Services.

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Authors and Affiliations

  1. Faculty of Economics, Business Department, University of Paris X, Paris, France

    Christine Huttin

  2. Agency for Healthcare Research and Quality, Center for Cost and Financing Studies, Rockville, Maryland, USA

    John F. Moeller

  3. Partners/Massachusetts General Hospital, Institute for Health Policy, Boston, Massachusetts, USA

    Randall S. Stafford

Authors
  1. Christine Huttin
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  2. John F. Moeller
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  3. Randall S. Stafford
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Correspondence to Christine Huttin.

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Huttin, C., Moeller, J.F. & Stafford, R.S. Patterns and Costs for Hypertension Treatment in the United States. Clin. Drug Investig. 20, 181–195 (2000). https://doi.org/10.2165/00044011-200020030-00006

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  • DOI: https://doi.org/10.2165/00044011-200020030-00006

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