The economics of mild hypertension programmes.

The recently reported results from several controlled randomised trials of the drug treatment of mild hypertension suggest that such treatment may be expected to exert a small effect toward the primary prevention of stroke disease. In order that the economic implications of these results might be examined, two hypothetical programmes of anticipatory care are considered according to the principles of cost-effectiveness analysis. Each notional 5 year programme is set in a defined population, residents of Stockport, Greater Manchester, aged between 35 and 64 years, and each is addressed toward the detection and treatment of mild hypertension in the community. The programmes differ with respect to their detection processes: one programme is based upon the screening method conducted under the aegis of health visitor staff employed by a District Health Authority, the other upon opportunistic case finding conducted by general practitioners. It is likely that the screening programme would prevent about 13 strokes over a 5 year period; if set in leisure time total programme costs are estimated to be 309,500 pounds at 1986 prices. Discounting future costs and future prevented strokes provides for the development of a present value total cost per prevented stroke of 25,000 pounds. Alternately, the 5 year opportunistic programme, costing 252,650 pounds, would be expected to prevent about 15 strokes at a present value of 17,050 pounds per prevented stroke. The prevention of stroke disease attributable to these programmes can only be achieved in the presence of group compliance to drug treatment. This clearly depends upon the perception of the value of treating hypertension according to each individual subject. The respective merits of the two programmes are examined with particular reference to their sensitivity to this issue, as well as to their likely feasibility and practicability.