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A cost benefit analysis for the treatment and detection of mild hypertens in Australia


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Claessens, MJ 1984 , 'A cost benefit analysis for the treatment and detection of mild hypertens in Australia', Honours thesis, University of Tasmania.

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Hypertension has long been recognized as a significant
health problem in Australia. Since the condition results in
reduced life expectancy, and employability, requiring careful
monitoring and life long therapy, the choice of treatments
requires special care. Mild hypertension is symptomless, and
accounts for seventy percent of all cases of hypertension. Most
mild hypertensives are unaware of their condition.
Chapter one of this dissertation is largely concerned with
an outline of the pr~valence and the principal means of
detection and treatment of the condition. The cost of lifelong
drug therapy, currently the primary means of treatment, is high.
A comparison with the alternative non-drug treatments is
therefore called for. The aims of this analysis are consistent
with guidelines for hypertension control recommended by the
National Heart Foundation of Australia.
The rest of chapter one, justifies the use of cost-benefit
analysis in indicating the desirability or otherwise of
government intervention in the market for health care. It is
argued that market failure prevents individual decision makers
from rationally evaluating the worth of their human capital.
Market failure is evident in insurance, lifestyle and through
the generation of externalities. The analysis should help to indicate whether a control programme is economically viable,
which treatments should be used and who should be treated.
Chapter two introduces the taxonomy of benefits and costs
used i.e. direct and indirect, visible and invisible savings in
morbidity and mortality, which are the major benefits of
effective hypertension control. The human capital and
willingness to pay approaches for valuation of life are
examined. Both approaches can be drawn together when we view
insurance and lifestyle as a reflection of individuals
willingness to pay, to maintain and increase his own human
capital. The permanent ipcome hypothesis can be used to justify
valueing pensioners time at the market wage. We must assume that
maximising Gross National Product (G.N.P.) does not provide a
basis for human capital valuation.
Choice of the real discount rate presents some
difficulties. Arguments that it ought to reflect the social rate
of time preference and the opportunity cost of capital are
discussed. The use of the risk-free bond rate is viewed as a
reliable proxy.
Chapter three examines the benefits (averted costs) of
effective control of mild hypertension. A mortality model is
developed upon the basis of human capital valuation, yielding
the present value of losses for the condition. The stock-flow
considerations, largely ignored in other studies are examined.
Morbidity costs are categorized by hospitalization, future treatment and loss in labour productivity. An understatement in
estimates is likely given the difficulty in quantifying some
indirect costs.
Chapter four, follows a probabilistic approach in
specifying the linkages between diagnosis, treatment and
outcome. The costs of treatment consist of screening, drug
treatment and the 'salt-modified' diet (non-drug treatment).
Sensitivity analysis is performed upon two alternative treatment
mixes i.e. diuretic drugs provide the primary course of
treatment (the 70% assumption) and non-drug treatment as the
initial therapy (the 20% ~ssumption).
Chapter five reviews the findings of the cost-benefit
analysis. In the aggregate social costs are outweighed by social
benefits. A programme based upon salt-diet modification as the
primary treatment yields the highest net benefit. Benefit cost
ratios suggest that, ideally, the programme should be directed
at males aged 65 to 69.
Research procedures followed consisted primarily of a
review of recent epidemiological studies performed in Australia,
the United Kingdom and the United States. Economic analysis, in
hypertension research, has been confined largely to costeffective
analyses. The increasing sophistication of costeffective
analyses and their scope for capturing the
nonpecuniary value of saving life, avoiding suffering etc, accounts for the growing usurpation of cost-benefit by cost
effective analysis, in health care.
More significantly, the use of quality-adjusted life years,
as a measure of health output, provides information more readily
appreciated by members of the medical profession, generally
lacking formal training in economics.
The Australian National Blood Pressure Study and the Risk
Factor Prevalence Study (National Heart Foundation of Australia
1980) were the primary sources of data. While information on
mortality rates is available on an annual basis, very little is
available on the incidence of non-fatal events i.e. for stroke
and myocardial infarction. Estimates of hypertension related
events were inferred. Dissaggregated data on deaths from heart
and blood vessel disease, provided by the N.H.F., were received
too late to be adequately incorporated.
The benefits and efficacy of drug/non drug treatment of
mild hypertension remains a contentious issue in epidemiological
circles. The forthcoming Medical Research Council Trial (U.K.)
should provide more exhaustive information regarding
hypertensive related events, and age/sex related benefits of
diuretic and beta-blocker therapy, than that currently
The analysis undertaken is exploratory in nature. The
findings largely confirm those views held by the medical profession for the need for concerted efforts at eradicating
mild hypertension in Australia.
The magnitude of the net benefits are particularly
sensitive to choice of adherence-to-therapy probabilities and
stock-flow modelling. A more complete analysis is required which
incorporates sensitivity to adherence rates, and a purpose built
demographic model. A cost-benefit program examining both blood
pressure and cholesterol, as the major risk factors in
heart,disease would be informative.
I wish to thank Bob Rutherford, my supervisor, for
assistance provided throughout the preparation of this thesis.
Thanks must also go to William Magill, Dr. Trevor Beard (of The
Canberra National Blood Pressure Trial) and Stan Crane (of The
National Heart Foundation of Australia) for advice and
suggestions, (reely given; and to Lyn Kumpulainen the typist.

Item Type: Thesis - Honours
Authors/Creators:Claessens, MJ
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