Those with hypertension had roughly 2.5 times more inpatient costs, almost twice the outpatient cost, and roughly triple the prescription medication cost annually.
Elizabeth Kirkland, MD, MSCR
In comparison with those without, patients with hypertension have an estimated $2000 more in health care expenditures annually, equating to an adjusted national expenditure of $131 billion, according to a new analysis.
Those with hypertension had roughly 2.5 times more inpatient costs, almost twice the outpatient cost, and roughly triple the prescription medication cost annually. However, this cost for patients has remained steady the last 12 years.
The analysis, led by Elizabeth Kirkland, MD, MSCR, an assistant professor of internal medicine at the Medical University of South Carolina, utilized data from the Medical Expenditure Panel Survey to make its calculations via a 2-part model over the period from 2003 to 2014. The data included 224,920 adults in the US, of which 36.9% had hypertension (n = 83,018).
"We already knew, based on prior work, that hypertension is the costliest of all cardiovascular disease- thus a huge health issue for patients of those practicing cardiology and metabolic health," Kirkland told MD Magazine. "Our findings add to prior work [done by Heidenreich et. al.] by updating cost with more recent data, looking at hypertension isolated from other cardiovascular diseases, and by examining the trends in cost over 12 years."
The findings revealed that the unadjusted mean annual cost (inflated to 2016 US dollars) was $9089 (95% CI, $8900 to $9278) for patients with hypertension, compared to $4172 (95% CI, $4066 to $4277) for those without. From 2011—2014, the total unadjusted mean expenditure for those with hypertension slightly decreased, from $9150 (95% CI, $8845 to $9455) from 2003–2006, to $9050 (95% CI, $8712 to $9388).
Annually, the unadjusted average spend for those with hypertension, inpatient and outpatient, were $2731 and $2791, respectively. In comparison with those costs for those without hypertension, the yearly outpatient and inpatient costs were much lower—$1093 and $1542, respectively.
"The cost burden of hypertension on population level and patient level expenditures is undeniable and highlights an ongoing need to remain vigilant in prevention, early detection, and treatment of hypertension," Kirkland said. "That being said, one might find consolation in that hypertension-related costs are not dramatically rising, unlike the trajectory of the overall per-capita health care expenditures in the US."
The adjusted incremental expenditure for individuals with hypertension was estimated at $1920 (95% CI, $1724 to $2117) more than their non-hypertensive counterparts. Those with hypertension aged 65—85 years spend $2453 (95% CI, $2213 to $2694; P <.001) annually, and those aged 45—64 years spend $1708 (95% CI, $1496 to $1920; P <.001) yearly.
A major difference in spending was related to prescription medication expenses, where patients with hypertension spent $2371 annually compared to the $814 spent by those without hypertension.
The authors noted that while the cost difference for patients with hypertension was significant, the stability of these additional costs is “promising” as they appear to be shifting from the inpatient setting to the outpatient setting. The only expense that showed a statistically significant increase over time was the unadjusted emergency department spend.
Kirkland and colleagues suggested that this trend could reflect overall decreases in hospitalization rates, lengths of stay, procedures, and/or readmissions. It could also suggest that there have been positive impacts in the improvements made in diagnosis, treatment, and management of hypertension, “marking a shift towards preventative rather than reactive care.” That would be a welcome sign, as last year’s update to the American Heart Association (AHA) and American College of Cardiology (ACC) hypertension guidelines, resulted in roughly 31.3 million additional patients qualifying as hypertensive—an increase of approximately 13.5%.
Kirkland noted that the AHA/ACC updated guideline will likely have an impact on this spending, although a sure prediction is tough to nail down. "Our hypothesis is that more US adults will now meet the definition for hypertension. This will increase the number in the affected population, which we would expect to increase the overall societal or population cost," she said. "On the other hand, the addition of these patients at the lower end of the BP range may be overall healthier and may not see higher costs, as diet and exercise may be recommended treatments, rather than starting new medications, for example. Thus, patient-level costs may not change, or may even drop on average."
National medical expenses related to the blood pressure condition are estimated to cost more than 3% of the overall health care spending, accounting for $131 billion in national costs. The authors explained this disparity with the estimates of $51.2 billion made by the AHA may be due to prevalence estimation differences.
As these costs continue to increase, Kirkland and colleagues noted that “it is imperative that we identify effective strategies to improve control of chronic diseases that are associated with high annual expenditures.”
The study, “Trends in Healthcare Expenditures Among US Adults With Hypertension: National Estimates, 2003—2014,” was published in JAHA.