The costs of treating hypertension: what are the long-term realities of cost containment and pharmacoeconomics?

Cost containment is an important force in medicine today, and there is ample reason to believe that it will soon target the No. 1 health problem for which Americans visit physicians--hypertension. The greatly streamlined (and cost-limited) initial evaluation of hypertensive patients suggested by the latest report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure is but one example. Acquisition cost is certainly an important factor in choice of a drug, but it is only one aspect of total cost of care. Limiting pharmacy benefits may produce short-term cost savings but may lead to unanticipated long-term increases in the healthcare budget. Prescribing large numbers of pills or an increased strength to allow pill-splitting and dispensing free medications provided by many pharmaceutical companies are ways some physicians are limiting the cost of antihypertensive drug therapy for patients. More research and sharing of information are necessary before easily generalizable conclusions can be drawn about the long-term pharmacoeconomics of hypertension therapy.