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      The potential savings of using thiazides as the first choice antihypertensive drug: cost-minimisation analysis

      , 1 , 1 , 1

      BMC Health Services Research

      BioMed Central

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          Abstract

          Background

          All clinical practice guidelines recommend thiazides as a first-choice drug for the management of uncomplicated hypertension. Thiazides are also the lowest priced antihypertensive drugs. Despite this, the use of thiazides is much lower than that of other drug-classes. We wanted to estimate the potential for savings if thiazides were used as the first choice drug for the management of uncomplicated hypertension.

          Methods

          For six countries (Canada, France, Germany, Norway, the UK and the US) we estimated the number of people that are being treated for hypertension, and the proportion of them that are suitable candidates for thiazide-therapy. By comparing this estimate with thiazide prescribing, we calculated the number of people that could switch from more expensive medication to thiazides. This enabled us to estimate the potential drug-cost savings. The analysis was based on findings from epidemiological studies and drug trials, and data on sales and prescribing provided by IMS for the year 2000.

          Results

          For Canada, France, Germany, Norway, the UK and the US the estimated potential annual savings were US$13.8 million, US$37.4 million, US$72.2 million, US$10.7 million, US$119.7 million and US$433.6 million, respectively.

          Conclusions

          Millions of dollars could be saved each year if thiazides were prescribed for hypertension in place of more expensive drugs. Our calculations are based on conservative assumptions. The potential for savings is likely considerably higher and may be more than US$1 billion per year in the US.

          Related collections

          Most cited references 30

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          The sixth report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure.

          Racial and ethnic minority populations are growing segments of our society. The prevalence of hypertension in these populations differs across groups, and control rates are not as good as in the general population. Clinicians should be aware of these management challenges, taking social and cultural factors into account. Guidelines are provided for management of children and women with hypertension. In older persons, diuretics are preferred and long-acting dihydropyridine calcium antagonists may be considered. Specific therapy for patients with LVH, coronary artery disease, and heart failure are outlined. Patients with renal insufficiency with greater than 1 g/d of proteinuria should be treated to a therapy blood pressure goal of 125/75 mm Hg; those with less proteinuria should be treated to a blood pressure goal of 130/85 mm Hg. ACE inhibitors have additional renoprotective effects over other antihypertensive agents. Patients with diabetes should be treated to a therapy blood pressure goal of below 130/85 mm Hg. Hypertension may coexist with various other conditions and may be induced by various pressor agents.
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            Changing provider behavior: an overview of systematic reviews of interventions.

            Increasing recognition of the failure to translate research findings into practice has led to greater awareness of the importance of using active dissemination and implementation strategies. Although there is a growing body of research evidence about the effectiveness of different strategies, this is not easily accessible to policy makers and professionals. To identify, appraise, and synthesize systematic reviews of professional educational or quality assurance interventions to improve quality of care. An overview was made of systematic reviews of professional behavior change interventions published between 1966 and 1998. Forty-one reviews were identified covering a wide range of interventions and behaviors. In general, passive approaches are generally ineffective and unlikely to result in behavior change. Most other interventions are effective under some circumstances; none are effective under all circumstances. Promising approaches include educational outreach (for prescribing) and reminders. Multifaceted interventions targeting different barriers to change are more likely to be effective than single interventions. Although the current evidence base is incomplete, it provides valuable insights into the likely effectiveness of different interventions. Future quality improvement or educational activities should be informed by the findings of systematic reviews of professional behavior change interventions.
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              Major Outcomes in High-Risk Hypertensive Patients Randomized to Angiotensin-Converting Enzyme Inhibitor or Calcium Channel Blocker vs Diuretic: The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT)

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                Author and article information

                Journal
                BMC Health Serv Res
                BMC Health Services Research
                BioMed Central (London )
                1472-6963
                2003
                8 September 2003
                : 3
                : 18
                Affiliations
                [1 ]Department of Health Services Research, Norwegian Directorate for Health and Social Affairs, N-0031 Oslo, Norway
                1472-6963-3-18
                10.1186/1472-6963-3-18
                201005
                12959644
                Copyright © 2003 Fretheim et al; licensee BioMed Central Ltd. This is an Open Access article: verbatim copying and redistribution of this article are permitted in all media for any purpose, provided this notice is preserved along with the article's original URL.
                Categories
                Research Article

                Health & Social care

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