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Following BP Guidelines Could Save Money

Wider Use of Diuretics Among Elderly Could Save $1.2 Billion
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WebMD Health News

April 21, 2004 -- A national savings of more than a billion dollars a year could be realized among elderly patients if doctors followed new high blood pressure treatment guidelines, a report from Harvard Medical School suggests.

Those guidelines call for the use of diuretics, commonly referred to as "water pills," as the first drug of treatment for most patients with high blood pressure. Far cheaper than newer high blood pressure medications, these drugs were found to work equally well or better in controlling high blood pressure and preventing heart failure and stroke in a widely publicized, federally funded study published late in 2002.

Although the economic impact of the recommendation is not yet known, hypertension experts tell WebMD that the change in clinical practice has been slow.

"This is a very good class of anti-hypertension drugs, but nobody has an economic interest in promoting them," American Heart Association spokesman Daniel Jones, MD, tells WebMD. "The fact that this message is not backed by any commercial interest is a big disadvantage."

$1.2 Billion in Savings

More than 60% of Americans who are 65 and older have high blood pressure, and estimates of the annual cost of treating these patients range from $7 billion to $15 billion a year.

In their cost analysis, Harvard researchers examined medication usage patterns among 133,624 elderly patients receiving treatment for high blood pressure who were enrolled in a drug assistance program in Pennsylvania. More than 2 million prescriptions for hypertension drugs were filled, at an annual cost of about $49 million, or $363 per patient.

Researchers Michael A. Fischer, MD, and Jerry Avorn, MD, say different drugs could have been prescribed in 40% of cases for a cost savings of $11.6 million.

Other types of blood pressure treatment drugs, including calcium channel blockers, costing approximately $34 per prescription, were prescribed most often, followed by ACE-inhibitors, costing roughly $25 per prescription, and beta-blockers, which cost about $15. Diuretics, costing about $5 per prescription, were prescribed less than 5% of the time.

At a national level, the researchers estimated that following the new guidelines would save elderly patients $1.2 billion annually.

"These days, physicians are struggling to find ways to provide good care for less money," Fischer tells WebMD. "Here is a case where we can treat most patients with less expensive drugs that have the same efficacy or better."

Change May Be Slow

Tulane University epidemiology professor Paul Whelton, MD, who headed the study that led to the high blood pressure treatment guideline changes, says it may be a year or more before good figures on the use of diuretics for the treatment of high blood pressure emerge. Earlier figures suggest that diuretics are used, either alone or with other medications, by about 20% of people being treated for high blood pressure.

He agrees with Jones that change may come slowly because of the aggressive promotion of the newer and more profitable drugs to clinicians and the public.

"The other drugs certainly have their place in treatment, but the reality is that there is no evidence that they work any better for most patients," he tells WebMD. "In fact, our study showed the opposite to be true."

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