Hostname: page-component-cd9895bd7-lnqnp Total loading time: 0 Render date: 2024-12-25T04:29:56.089Z Has data issue: false hasContentIssue false
  • English
  • Français

Economic Evaluation of Hypertension Treatment

Published online by Cambridge University Press:  14 October 2009

Magnus Johannesson
Magnus Johannesson
Affiliation:
Stockholm School of Economics
Get access Rights & Permissions [Opens in a new window]

Abstract

A computer simulation model shows that the cost-effectiveness of treating hypertension is highly sensitive to different assumptions about the effectiveness of treatment, the outcome measure, the cost concept, the discounting of effects, and the duration of therapy. Cost-effectiveness analysis should be supplemented by another approach–cost-benefit analysis based on the contingent valuation (CV) method (the measurement, by survey, of willingness to pay). The CV method is tested in two empirical applications that indicate that it is possible to use the method in this area. Its results should be interpreted with caution, however, since the reliability and validity of the method is not yet established.

Type
General Essays
Information
International Journal of Technology Assessment in Health Care , Volume 8 , Issue 3 , Summer 1992 , pp. 506 - 523
Copyright
Copyright © Cambridge University Press 1992

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1.Acton, J. P. Evaluating public programs to save lives: The case of heart attacks. Santa Monica, CA: RAND report R-950-RC, 1973.Google Scholar
2.Amery, A., Brixko, P., Clement, D., et al. Mortality and morbidity results from the European working party on high blood pressure in the elderly trial. Lancet, 1985, ii, 1349–54.CrossRefGoogle Scholar
3.Bishop, R. C., & Heberlein, J. A.Measuring values of extra market goods: Are indirect measures biased? American Journal of Agricultural Economics, 1979, 61, 926–30.CrossRefGoogle Scholar
4.Bowker, J. M., & Stoll, J. R.Use of dichotomous choice nonmarket methods to value the whooping crane resource. American Journal of Agricultural Economics, 1988, 70, 372–81.Google Scholar
5.Boyle, K. J., & Bishop, R. C.Welfare measurements using contingent valuation: A comparison of techniques. American Journal of Agricultural Economics, 1988, 70, 21–28.Google Scholar
6.British Hypertension Society Working Party. Treating mild hypertension. British Medical Journal, 1988, 298, 694–98.Google Scholar
7.Brookshire, D. S., Randall, A., & Stoll, J. R.Valuing increments and decrements of natural resource service flows. American Journal of Agricultural Economics, 1980, 62, 478–88.CrossRefGoogle Scholar
8.Brookshire, D. S., Thayer, M. A., Schulze, W. P., & d'Arge, R. C.Valuing public goods: Comparison of survey and hedonic approaches. American Economic Review, 1982, 72, 165–77.Google Scholar
9.Cameron, T. A.A new paradigm for valuing non-market goods using referendum data: Maximum likelihood estimation by censored logistic regression. Journal of Environmental Economics and Management, 1988, 13, 255–68.Google Scholar
10.Cantor, J. C., Morisky, D. E., Green, L. W., et al. Cost-effectiveness of educational interventions to improve patient outcomes in blood pressure control. Preventive Medicine, 1985, 14, 782–800.Google Scholar
11.Carson, R. T. Constructed markets. In Braden, J. B. & Kolstad, C. D. (eds.), Measuring the demand for environmental quality. Amsterdam: Elsevier/North Holland, 1991.Google Scholar
12.Collins, R., Peto, R., MacMahon, S., et al. Blood pressure, stroke, and coronary heart disease, part 2, short term reductions in blood pressure: Overview of randomised drug trials in their epidemiological context. Lancet, 1990, 335, 827–38.CrossRefGoogle ScholarPubMed
13.Cummings, R. G., Brookshire, D. S., & Schulze, W. D.Valuing environmental goods. New Jersey: Rowman and Allanheld, 1986.Google Scholar
14.Edelson, J. T., Weinstein, M. C., Tosteson, A. N., et al. Long-term cost-effectiveness of various initial monotherapies for mild to moderate hypertension. Journal of the American Medical Association, 1990, 263, 407–13.Google Scholar
15.Edgar, M. A., & Schnieden, H.The economics of mild hypertension programmes. Social Science and Medicine, 1989, 28, 211–22.Google Scholar
16.Erfurt, J. C., & Foote, A.Cost-effectiveness of work-site blood pressure control programs. Journal of Occupational Medicine, 1984, 26, 892–900.CrossRefGoogle ScholarPubMed
17.Gegax, D., Gerking, S., & Schulze, W. Perceived risk and the marginal value of safety. Working paper prepared for the U.S. Environmental Protection Agency, 1985.Google Scholar
18.Hammack, B., & Brown, G. M., Jr. Waterfowl and wetlands: Toward bioeconomic analysis. Baltimore, MD: Johns Hopkins University Press for Resources for the Future, 1974.Google Scholar
19.Hanemann, M. W.Welfare evaluations in contingent valuation experiments with discrete responses. American Journal of Agricultural Economics, 1984, 66, 332–41.CrossRefGoogle Scholar
20.Helgeland, A.Treatment of mild hypertension: A five-year controlled drug trial, the Oslo study. American Journal of Medicine, 1980, 69, 725–32.Google Scholar
21.Hypertension Detection and Follow-up Program Cooperative Group. Five-year findings of the hypertension detection and follow-up program, I, reduction in mortality of persons with high blood pressure, including mild hypertension. Journal of the American Medical Association, 1979, 242, 2562–71.CrossRefGoogle Scholar
22.Hypertension Detection and Follow-up Program Cooperative Group. Five-year findings of the hypertension detection and follow-up program, II, mortality by race, sex and age. Journal of the American Medical Association, 1979, 242, 2572–77.CrossRefGoogle Scholar
23.Hypertension Detection and Follow-up Program Cooperative Group. Five-year findings of the hypertension detection and follow-up program, III, reduction in stroke incidence among persons with high blood pressure. Journal of the American Medical Association, 1982, 247, 633–38.CrossRefGoogle Scholar
24.Hypertension Detection and Follow-up Program Cooperative Group. The effect of treatment on mortality in “mild” hypertension: Results of the hypertension detection and follow-up program. New England Journal of Medicine, 1982, 307, 976–80.CrossRefGoogle Scholar
25.Hypertension Detection and Follow-up Program Cooperative Group. Effect of stepped care treatment on the incidence of myocardial infarction and angina pectoris, 5-year findings of the hypertension detection and follow-up program. Hypertension, 1984, 6(suppl. I), 198–206.Google Scholar
26.Johannesson, M.Economic evaluation of hypertension treatment. Linköping University, Sweden: Linköping Studies in Arts and Science Nr 67, 1991.Google ScholarPubMed
27.Johannesson, M.Buchanan's opportunity cost concept, the contingent valuation method and cost-benefit analysis. Journal des Economistes et des Etudes Humaines, 1991, 2, 123–33.Google Scholar
28.Johannesson, M.A note on the discounting of gained life-years in cost-effectiveness analysis. International Journal of Technology Assessment in Health Care, 1992, 8, 359–68.CrossRefGoogle Scholar
29.Johannesson, M., Åberg, H., Agréus, L., et al. Cost-benefit analysis of non-pharmacological treatment of hypertension. Journal of Internal Medicine, 1991, 230, 307–12.CrossRefGoogle ScholarPubMed
30.Johannesson, M., Borgquist, L., & Jönsson, B.The costs of treating hypertension in Sweden: An empirical investigation in primary health care. Scandinavian Journal of Primary Health Care, 1991, 9, 155–60.CrossRefGoogle ScholarPubMed
31.Johannesson, M., Borgquist, L., Jönsson, B., & Råstam, L.The costs of treating hypertension: An analysis of different cut-off points. Health Policy, 1991, 18, 141–50.CrossRefGoogle ScholarPubMed
32.Johannesson, M., Hedbrant, J., & Jönsson, B.A computer simulation model for cost-effectiveness analysis of cardiovascular disease prevention. Medical Informatics, 1991, 16, 355–62.CrossRefGoogle ScholarPubMed
33.Johannesson, M., & Jönsson, B. Cost-effectiveness analysis of hypertension treatment: Methodological issues. Linköping University, Sweden: Center for Medical Technology Assessment, CMT report, 1990.Google Scholar
34.Johannesson, M., & Jönsson, B.Cost-effectiveness analysis of hypertension treatment: A review of methodological issues. Health Policy, 1991, 19, 55–78.Google Scholar
35.Johannesson, M., & Jönsson, B.Economic evaluation in health care: Is there a role for cost-benefit analysis? Health Policy, 1991, 17, 1–23.Google Scholar
36.Johannesson, M., Jönsson, B., & Borgquist, L.Willingness to pay for antihypertensive therapy: Results of a Swedish pilot study. Journal of Health Economics, 1991, 10, 461–74.CrossRefGoogle ScholarPubMed
37.Johansson, P.-O.The economic theory and measurement of environmental benefits. Cambridge, U.K.: Cambridge University Press, 1987.CrossRefGoogle Scholar
38.Jones-Lee, M. W.The value of life: An economic analysis. London: Martin Robertson, 1976.Google Scholar
39.Jones-Lee, M. W., Hammerton, M., & Philips, P. R.The value of safety: Results of a national sample survey. Economic Journal, 1985, 95, 49–72.Google Scholar
40.Jönsson, B.Ekonomiska konsekvenser av de nya behandlingsriktlinjerna mot hypertoni. In Berglund, G. (ed.), Hypertoni 87, Mölndal: Hässle Läkemedel AB, 1988.Google Scholar
41. Jönsson, B. Applications of cost-benefit analysis to health problems. In Halberstadt, V. & Culyer, A. J. (eds.), Public economics and human resources. Proceedings of the 31st congress of the International Institute of Public Finance. Editions Cujas, 1977.Google Scholar
42.Jönsson, B.Cost-benefit analysis in public health and medical care. Lund: Liber, 1976.Google Scholar
43.Jönsson, B., Horisberger, B., Bruguera, M., & Matter, L.Cost-benefit analysis of hepatitis-B vaccination: A computerized model for Spain. International Journal of Technology Assessment in Health Care, 1991, 7, 379–402.Google Scholar
44.Kannel, W. B., Wolf, P. A., & Garrison, R. J. (eds.). The Framingham study: An epidemio-logical investigation of cardiovascular disease, section 34, some risk factors related to the annual incidence of cardiovascular disease and death using pooled repeated biennial measurements, 30-year follow-up. Springfield, IL: U.S. Department of Commerce, National Technical Information Service, 1987.Google Scholar
45.Kannel, W. B., Wolf, P. A., & Garrison, R. J. (eds.). The Framingham study: An epidemio-logical investigation of cardiovascular disease, section 37, the probability of developing certain cardiovascular diseases in eight years at specified values of some characteristics. Springfield, IL: U.S. Department of Commerce, National Technical Information Service, 1987.Google Scholar
46.Kawachi, I., & Malcolm, L. A.The cost-effectiveness of treating mild-to-moderate hypertension: A reappraisal. Journal of Hypertension, 1991, 9, 199–208.CrossRefGoogle ScholarPubMed
47.Keeler, E. B., & Cretin, S.Discounting of life-saving and other nonmonetary effects. Management Science, 1983, 29, 300–06.CrossRefGoogle Scholar
48.Keys, A.Seven countries. Cambridge, MA: Harvard University Press, 1980.CrossRefGoogle ScholarPubMed
49.Knetsch, J. L., & Sinden, J. A.Willingness to pay and compensation demanded: Experimental evidence of an unexpected disparity in measures of value. Quarterly Journal of Economics, 1984, 98, 507–21.CrossRefGoogle Scholar
50.Kriström, B. Valuing environmental benefits using the contingent valuation method: An econometric analysis. Ph.D. dissertation. University of Umeå: Umeå Economic Studies No. 219, 1990.Google Scholar
51. Kriström, B. Discrete and continuous valuation questions; Do they give different answers? Swedish University of Agricultural Sciences in Umeå: Department of Forest Economics, Working paper 90, 1989.Google Scholar
52.Kriström, B.A nonparametric approach to the estimation of welfare measures in discrete response valuation studies. Land Economics, 1990, 66, 135–39.CrossRefGoogle Scholar
53.Laaser, U., & Wenzel, H.Antihypertensive treatment in Germany, subjected to a cost-effectiveness analysis. Journal of Human Hypertension, 1990, 4, 436–40.Google Scholar
54.Lindgren, B., & Persson, U.The cost-effectiveness of a new antihypertensive drug, dox-azosin. Current Therapeutic Research, 1989, 45, 738–60.Google Scholar
55.Littenberg, B., Garber, A. M., & Sox, H. C.Screening for hypertension. Annals of Internal Medicine, 1990, 112, 192–202.CrossRefGoogle ScholarPubMed
56.Logan, A. G., Milne, B. J., Achber, C., et al. Cost-effectiveness of a worksite hypertension treatment programme. Hypertension, 1981, 3, 211–18.Google Scholar
57.Läkemedelsstatistik, AB.Swedish drug market (SDM) 89:3. Stockholm: Läkemedelsstatistik AB, 1989.Google Scholar
58.MacMahon, S., Peto, R., Cutler, J., et al. Blood pressure, stroke, and coronary heart disease, part 1, prolonged differences in blood pressure: Prospective observational studies corrected for the regression dilution bias. Lancet, 1990, 335, 765–74.Google Scholar
59.Medical Research Working Party. MRC trial of treatment of mild hypertension: Principal results. British Medical Journal, 1985, 291, 97–104.Google Scholar
60.Mishan, E. J.Evaluation of life and limb: A theoretical approach. Journal of Political Economy, 1971, 79, 687–705.Google Scholar
61.Mitchell, R. C., & Carson, R. T.Using surveys to value public goods. Washington, DC: Resources for the Future, 1989.Google Scholar
62.Mitchell, R. C., & Carson, R. T. An experiment in determining willingness to pay for national water quality improvements. Draft report prepared for the U.S. Environmental Protection Agency. Washington, DC: U. S., Environmental Protection Agency, 1981.Google Scholar
63.Multiple Risk Factor Intervention Trial Research Group. Multiple risk factor intervention trial, risk factor changes and mortality results. Journal of the American Medical Association, 1982, 248, 1465–67.Google Scholar
64.National Board of Health and Welfare Drug Information Committee. Treatment of mild hypertension. Uppsala: National Board of Health and Welfare, 1987.Google Scholar
65.Nissinen, A., Tuomilehto, J., Kottke, T. E., & Puska, P.Cost-effectiveness of the North Karelia hypertension program 1972–1977. Medical Care, 1986, 24, 767–80.Google Scholar
66.OECD. Financing and delivering health care, a comparative analysis of OECD countries. Paris: OECD, 1987.Google Scholar
67.Randall, A., Grunewald, O., Pagoulatos, A., et al. Reclaiming coal surface mines in central Appalachia: A case study of the benefits and costs. Land Economics, 1978, 54, 472–89.Google Scholar
68.Randall, A., Ives, B. C., & Eastman, C.Bidding games for valuation of aesthetic environmental improvements. Journal of Environmental Economics and Management, 1974, 1, 132–49.Google Scholar
69.Råstam, L., Berglund, G., Isacsson, S-O., & Ryden, L.The Skaraborg hypertension project. Acta Medica Scandinavica, 1986, 219, 243–69.Google Scholar
70.Report by the Management Committee. The Australian therapeutic trial in mild hypertension. Lancet, 1980, 1261–67.Google Scholar
71.Rowe, R. D., d'Arge, R. C., & Brookshire, D. S.An experiment on the economic value of visibility. Journal of Environmental Economics and Management, 1980, 7, 1–19.Google Scholar
72.Russel, L.Is prevention better than cure? Washington, DC: Brookings Institution, 1986.Google Scholar
73.Schelling, T. C. The life you save may be your own. In Chase, S. B. (ed.), Problems in public expenditure analysis. Washington, DC: The Brookings Institution, 1968.Google Scholar
74.Smith, V. K. & Desvousges, W. H.Measuring water quality benefits. Boston, MA: Kluwer-Nijhoff Publishing, 1986.Google Scholar
75.Smith, V. K., & Desvousges, W. H.An empirical analysis of the economic value of risk changes. Journal of Political Economy, 1987, 95, 89–115.Google Scholar
76.Statistiska centralbyrån. Statistical abstract of Sweden 1990. Stockholm: Statistics Sweden, 1989.Google Scholar
77.Stevens, R. D., Bingley, L. J. JrBoger, M., et al. Variability in the management of hypertension and cost-effectiveness: Methodology, community care results and potential cost reductions. Social Science and Medicine, 1984, 18, 767–74.Google Scholar
78.Thompson, M. S.Willingness to pay and accept risks to cure chronic disease. American Journal of Public Health, 1986, 76, 392–96.Google Scholar
79.Tibblin, G., & Åberg, H.Non-pharmacological treatment of hypertension in two steps: 1 year report from eight health centres. Acta Medica Scandinavica, 1987, (suppl. 714), 105–12.Google Scholar
80.Veterans Administration Cooperative Study Group on Antihypertensive Agents. Effects of treatment on morbidity in hypertension: Results in patients with diastolic blood pressure averaging 115 through 129 mm Hg. Journal of the American Medical Association, 1967, 202, 1028–34.CrossRefGoogle Scholar
81.Veterans Administration Cooperative Study Group on Antihypertensive Agents. Effects of treatment on morbidity in hypertension, II, results in patients with diastolic blood pressure averaging 90 through 114 mm Hg. Journal of the American Medical Association, 1970, 213, 1143–52.CrossRefGoogle Scholar
82.Veterans Administration Cooperative Study Group on Antihypertensive Agents. Effects of treatment on morbidity in hypertension, III, influence of age, diastolic blood pressure, and prior cardiovascular disease; further analysis of side effects. Circulation, 1972, 45, 991–1004.CrossRefGoogle Scholar
83.Waaler, H., Helgeland, A., Hjort, P., et al. Hoyt blodtrykk: Behandlingsprogram, utbytte, kostnader. Oslo: Norges allmenvitenskapelige forskningsråds gruppe for helsetjenste-forskning, Rapport Nr 5, 1978.Google Scholar
84.Weinstein, M. C.Principles of cost-effective resource allocation in health care organizations. International Journal of Technology Assessment in Health Care, 1990, 6, 93–103.Google Scholar
85.Weinstein, M. C., & Stason, W. B.Hypertension: A policy perspective. Cambridge, MA: Harvard University Press, 1976.CrossRefGoogle Scholar
86.Weinstein, M. C., & Stason, W. B.Foundations of cost-effectiveness analysis for health and medical practices. New England Journal of Medicine, 1977, 296, 732–39.Google Scholar
87.Williams, A., & Sugden, R.The principles of practical cost-benefit analysis. Oxford: Oxford University Press, 1978.Google Scholar
88.Åberg, H., & Tibblin, G.Addition of non-pharmacological methods of treatment in patients on antihypertensive drugs: Results of previous medication, laboratory tests and life quality. Journal of Internal Medicine, 1989, 226, 39–46.Google Scholar