Economic Effects of Hypertension Treatment Guideline Implementation in Outpatient Practice

1. ECONOMIC EFFECTS OFIMPLEMENTING TREATMENT GUIDELINES FOR HYPERTENSION IN OUTPATIENT PRACTICEKulmagambetov IR, Muldaeva G, Nurmanbetova F, Kalieva SKaraganda State Medical Academy,Kazakhstan

2. ECONOMIC EFFECTS OFIMPLEMENTING TREATMENT GUIDELINES FOR HYPERTENSION IN OUTPATIENT PRACTICEKulmagambetov IR, Muldaeva G, Nurmanbetova F, Kalieva SKaraganda State Medical Academy,Kazakhstan Problem Statement: One of the problems in cardiology is evaluating the economic efficiency of the treatment of hypertension. Objectives: To assess the efficiency of hypertension treatment, the cost of hypertension drug therapy, and the quality of life of hypertension patients in the outpatient setting before and after implementation of hypertension treatment guidelines. Design: Retrospective analysis of patient records for patients with an established diagnosis of hypertension in outpatient practice before implementation of treatment guidelines for 2001–2002; the cost-effectiveness analysis of quality of life of patients; and the economic analysis of cost of treatment after implementation of guidelines. Setting and Population: At the center for primary health care and 2 general practice outpatient centers in Karaganda, 61 patients with an established diagnosis of hypertension: 13 men (21 %) aged 67.5±2.2 years and 48 women (79 %) ages 62.5±2.7 years. Intervention: In phase II, implementation of hypertension treatment guidelines. Outcome Measures: Percentage of cases achieving a target level of arterial pressure, percentage of patients for whom antihypertensive therapies were effective, percentage of patients developing complications (severe hypertensive crisis, acute stroke), expenses for treatment [USD], and patient quality of life was assessed by score range that was between –2 and 1, with higher scores indicating better health status. Results: Before implementation of treatment guidelines, the percentage of cases achieving a target level of arterial pressure was 14 %; 72 % of antihypertensive therapies were ineffective; and 14 % of hypertension patients developed complications. Expenses for treatment of 61 patients in the 6 months before implementation were USD 4, 728 and expenses average per patient were USD 77.5. After the intervention, achievement of a target level of arterial pressure was 71.4 %, the percentage of ineffective therapy decreased to 28.6 %, effective therapies increased by 57.4%, and development of complications was 0%. Expenses for treatment after the intervention were USD 1, 882 and expenses average per patient were USD 30.85, representing a reduction of USD 2, 846. Patient quality of life, was measured by score, showed an average improvement of 4.3±0.9for 82.9 % of patients; quality of a life did not change for 17.1 % of patients. Conclusions: Implementation of the treatment guidelines has increased efficiency in the management of hypertension and improved patient quality of life. The rational choices of effective pharmacotherapy following the implementation improved the of economy of treatment.

3. Introduction: One of the problems in cardiologyisevaluatingthe economic efficiency of the treatment of hypertensionSetting: At the center for primary health care and 2 general practice outpatient centers in Karaganda

4. Objectives: • To assess the efficiency of hypertension treatment • To assess the cost of hypertension drug therapy • To assess the quality of life of hypertension patients in the outpatient setting before and after implementation of hypertension treatment guidelines

5. Methods: • Retrospective analysis of 61 outpatients records with an established diagnosis of hypertension in outpatient practice for 2001 – 2002 • Statistical analysis carried out by calculation of a standard set of the parameters used in descriptive statistics

6. Methods: • The cost-effectiveness analysis • The patient quality of life was assessed by score range, with higher scores indicating better health status • The economic analysis of cost of treatment after implementation of guidelines

7. Methods: Expenses for treatment of hypertension patients was calculated at the rate of daily average dozes of medicines in USD. The prices of medicines used in this analysis are based on the 2002 average wholesale price list published in Newsletter “ Products and services on Kazakhstan market ”: a series "Public health services", issued with assistance of Ministry of Health Republic of Kazakhstan

8. Results: Before implementation of treatment guidelines: • the percentage of cases achieving a target level of arterial pressure was 14 % • the percentage of ineffective antihypertensive therapies were 72 % • the percentage of developing complications were 14 % of hypertension patients

9. Results: After the intervention: • achievement of a target level of arterial pressure was 71.4 % • the percentage of ineffective therapy decreased to 28.6 %, effective therapies increased by 57.4% • development of complications was 0%

10. The efficiency of hypertension treatment before and after implementation of treatment guidelines

11. Expenses for treatment of hypertension patients

12. Results: Patient quality of life, was measured by score, showed an average improvement of 4.3±0.9for 82.9 % of patients Quality of life did not change for 17.1 % of patients

13. Conclusions and recommendations: Implementation of the treatment guidelines has increased efficiency in the management of hypertension and improved patient quality of life The rational choices of effective pharmacotherapy following the implementation improved the of economy of treatment