Reducing Drug Costs For Hypertension

Main Category: Hypertension
Also Included In: Primary Care / General Practice
Article Date: 11 Jul 2007 - 15:00 PDT

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Research in Norway has shown that there have been substantial savings in drug costs since the introduction of a regulation requiring doctors to prescribe the recommended first-line treatment for hypertension (high blood pressure). Since March 2004, family doctors have been reimbursed for drug costs only if they prescribe thiazides as first-line therapy for uncomplicated hypertension, unless there are medical reasons for selecting other drugs. Atle Fretheim and colleagues, in a research article published in PLoS Medicine, show that the change in prescribing practices reduced drug costs per Norwegian by US$0.16 in the first year.

Antihypertensive drugs are a major part of national drug expenditure in developed countries, where as many as one person in ten is treated for hypertension. The different classes of antihypertensive are all effective but their costs vary widely. Thiazides, for example, are a tenth of the price of many non-thiazide drugs. In Norway, as in many other developed countries, guidelines were introduced to encourage doctors to use thiazides but the level of their use remained low. This led the government to impose the new reimbursement rule, with the aim of reducing public expenditure on antihypertensive drugs.

Before the change, one in ten patients starting antihypertensive medication was prescribed a thiazide drug. This proportion gradually increased during the transition period, before stabilizing at one in four patients throughout the post-intervention period. A slightly higher proportion of patients reached their recommended blood-pressure goal after the rule was introduced than before, though this small difference may have been due to chance. The fact that three-quarters of patients were still not getting thiazides indicates how hard it is to change what doctors prescribe.

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Everything published by PLoS Medicine is Open Access: freely available for anyone to read, download, redistribute and otherwise use, as long as the authorship is properly attributed.

Citation: Citation: Fretheim A, Håvelsrud K, MacLennan G, Kristoffersen DT, Oxman AD. (2007) The effects of mandatory prescribing of thiazides for newly treated, uncomplicated hypertension: Interrupted timeseries analysis. PLoS Med 4(7): e232.

LINK TO THE PUBLISHED PAPER:
http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0040232

CONTACT:
Atle Fretheim
Norwegian Knowledge Centre for the Health Services
K4
PO Box 7004, St. Olavs plass
N-0130 Oslo, 0130
Norway

About PLoS Medicine

PLoS Medicine is an open access, freely available international medical journal. It publishes original research that enhances our understanding of human health and disease, together with commentary and analysis of important global health issues. For more information, visit http://www.plosmedicine.org/

About the Public Library of Science

The Public Library of Science (PLoS) is a non-profit organization of scientists and physicians committed to making the world's scientific and medical literature a freely available public resource. For more information, visit http://www.plos.org/

Source: Andrew Hyde
Public Library of Science

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