Authors: Jacqueline Roseleur 1,2,5; David A. Gonzalez Chica 2,3; Gillian Harvey 4; Nigel P. Stocks 2; Jonathan Karnon 5
- School of Public Health, Faculty of Health Sciences, The University of Adelaide, Adelaide, SA, Australia
- Discipline of General Practice, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
- Adelaide Rural Clinical School, The University of Adelaide, Adelaide, SA, Australia
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
- Flinders Health and Medical Institute, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
The most common condition seen in Australian general practice is hypertension, or high blood pressure (BP), but despite being treatable, only around half of patients have controlled BP levels. This puts them at increased risk of cardiovascular disease (CVD). In this study, researchers estimated the health and acute hospitalisation costs of uncontrolled hypertension among patients aged 45-74 years who regularly attend general practice in Australia. They found that across all Australians in this age group who visit their general practitioner (around 8.67 million people), 261,858 CVD events can be expected over the next five years at current BP levels. This has a cost of AUD 1,813 million (in 2019-2020).
The researchers then looked at the potential cost savings for acute hospitalisation of primary CVD events by reducing the risk of a cardiovascular event over the next 5 years through improved BP control. They found that if all patients with a BP greater than 139 mmHg had their BP reduced to 139 mmHg, 25,845 CVD events could be avoided with an associated reduction in acute hospital costs of AUD 179 million. If BP is lowered further to 129mmHg for all those with a BP greater than 129 mmHg, 56,169 CVD events could be avoided with potential cost savings of AUD 389 million. Sensitivity analyses indicate that potential cost savings range from AUD 46 million to AUD 1,406 million and AUD 117 million to AUD 2,009 million for the two scenarios, respectively.
Cost savings by practice range from AUD 16,479 for small practices to AUD 82,493 for large practices. The researchers concluded that while the aggregate cost effects of poor BP control in primary care are high, the cost implications at the individual practice level are modest. The potential cost savings improve the potential to design cost-effective interventions, but such interventions may be best targeted at a population-level rather than at individual practices.
Overall, this study highlights the importance of controlling BP levels in patients attending general practice to reduce the risk of CVD and associated costs. By improving BP control, significant cost savings can be achieved in acute hospitalisation costs. This information may be useful for health policy makers and decision-makers in Australia to design effective interventions to improve BP control and reduce CVD-related costs.