Reducing costs and improving compliance

  • William W. Neal
    Address for reprints: William W. Neal, MD, Veterans Administration Medical Center, 4500 South Lancaster Road, Dallas, Texas 75216.
    From the Participating Investigator, Cooperative Studies Program on Antihypertensive Agents, Veterans Administration Medical Center, Dallas, Texas U.S.A.
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      The cost-effectiveness of antihypertensive therapy is defined as the costs of treatment less the savings from the prevention of stroke and myocardial infarction, relative to the therapeutic effectiveness of treatment. Since antihypertensive therapy actually increases the dollar cost of medical care, the use of more expensive agents needs to be justified in terms of better blood pressure control, improved quality of life, and reduced cardiovascular morbidity and mortality. Data from the clinical trials have not shown the more expensive agents such as angiotensin-converting enzyme inhibitors and calcium channel blockers to be superior to the less expensive agents such as diuretic drugs in reducing blood pressure or cardiovascular morbidity and mortality.
      Poor compliance may reduce both the effectiveness and cost-effectiveness of treatment. Physicians must play an active role in promoting compliance by assuring the patient's ability to incorporate the prescribed dosage regimen into daily routine, by actively monitoring compliance, by modifying the regimen appropriately to remove the cause of noncompliance, and by switching medication if it is ineffective or if adverse effects occur.
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