A cost-analysis of managing secondary and apparent treatment-resistant hypertension in a specialist multidisciplinary hypertension clinic

Author:

Rabbitt Louise1,Curneen James2,Hobbins Anna3,Browne Darragh4,Joyce Mary4,Lappin David5,McEvoy John William67,Gillespie Paddy3,Dennedy Michael Conall14

Affiliation:

1. Discipline of Pharmacology and Therapeutics, School of Medicine, University of Galway

2. Department of Clinical Pharmacology and Therapeutics, St James’ Hospital, Dublin

3. Centre for Research in Medical Devices (CÚRAM, SFI 13/RC/2073_P2) and Health Economics and Policy Analysis Centre, University of Galway, Ireland

4. Centre for Endocrinology, Diabetes and Metabolism

5. Department of Nephrology, Saolta University Healthcare Group (SUHCG), Galway University Hospitals

6. Department of Cardiology, School of Medicine, University of Galway

7. National Institute for Prevention and Cardiovascular Health, Galway, Ireland

Abstract

Objectives: A knowledge gap exists around the costs and budget impact of specialist hypertension clinics. This study reports on the cost of providing care in a multidisciplinary hypertension clinic staffed by nephrologist, endocrinologist and cardiologist, which manages patients with suspected secondary hypertension and/or apparent treatment-resistant hypertension. The aim of this study is to provide the evidence required to inform policy and planning care pathways for this patient group. Methods: A cost analysis from a healthcare provider perspective using micro-costing techniques was conducted to estimate the direct implementation costs of existing standard practice for the care pathway of patients attending the multidisciplinary hypertension clinic. Sixty-five patients originally recruited for a study of medication adherence in hypertension were included in the sample. Results: The total care-pathway cost per patient, taking into account clinic visits, clinical reviews, investigations and MDT discussion, was estimated to be €3277, on average. For the patient subgroups, the average cost was €5644 for patients diagnosed with primary aldosteronism and €1446 for patients diagnosed with essential hypertension. Conclusion: There is significant cost associated with providing specialized hypertension care for patients with apparent treatment-resistant hypertension. Given the high rates of nonadherence in this population, it is likely that some of this cost could be avoided with better detection and management of medication adherence in this challenging population. Future studies should consider the cost-effectiveness of this or similar models of care by exploring the benefit to patients and the wider healthcare context of providing care of this type.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Cardiology and Cardiovascular Medicine,Physiology,Internal Medicine

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