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Selected research from leading health care experts whose findings have a direct bearing on public policies effecting medical progress. Research is chosen based on its quality and relevance by the Medical Progress Today editorial staff.

Selected Research

The Impact of Antihypertensive Drugs on the Number and Risk of Death, Stroke and Myocardial Infarction in the United States
Ernst R. Berndt, David M. Cutler, Genia Long, NBER, 1-3-06

Is U.S. healthcare spending worth the price tag? Pundits like Dr. Gerber, as we noted above, tend to think that the U.S. is spends far too much to achieve far too little. But the answer to this question—the value of spending—depends critically on the variables being measured. The researchers in this NBER working paper present interesting evidence that U.S. healthcare spending—at least in certain disease categories—produces enormous healthcare value relative to expenditures.

In this research, we quantify the impact of antihypertensive therapy on U.S. blood pressures, risk and number of heart attacks, strokes, and deaths. We also consider the potential for further improvements. We estimate the value of innovation using equations relating blood pressure to adverse outcomes from the Framingham Heart Study.

Our results show that without antihypertensive therapy, 1999-2000 average blood pressure for the U.S. population age 40 plus would have been 10-13 percent higher. 86,000 excess premature deaths from cardiovascular disease (2001), and 833,000 hospital discharges for stroke and heart attacks (2002) would have occurred. Life expectancy would be 0.5 (men) and 0.4 (women) years lower. At guideline care, there would have been 89,000 fewer premature deaths (2001) and 420,000 fewer hospital discharges for stroke and heart attack (2002) than observed. Our analysis suggests that antihypertensive therapy has had a significant impact on cardiovascular health outcomes but that mortality gains would have been approximately twice as high if guideline care had been achieved for all.

What is the value of these health gains? The authors estimate "2002 total direct medical costs avoided due to fewer strokes and [myocardial infarction] of $10.7 billion and $5.8 billion, respectively" and that "including the impact of antihypertensive drugs on quality of life and work productivity would increase the benefit-cost ratio further."

Their research suggests that if we ignore gains from improved treatments, and blithely assume that lower spending leads linearly to lower total costs, we run the risk of actually hurting our economy and our health in the long run through short-sighted cost controls.



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