Measurement of health outcome and associated costs in cardiovascular disease.

As a result of scarcity of resources, combined with increased demand and the introduction of newer, more expensive technologies, choices have to be made about the allocation of funds between competing therapeutic options and priorities. Economic evaluation provides a means of making such choices more rational and the allocation of resources more efficient. Essentially, there are four types of health-economic evaluation: cost-minimization, cost-effectiveness, cost-utility and cost-benefit analysis. Costs associated with cardiovascular care amount to 12-13% of the Swedish healthcare budget. Most of the direct costs associated with treating cardiovascular disease are spent on inpatient care. The indirect costs associated with morbidity and mortality are much greater than direct costs. The treatment of hypertension provides a good example of how direct costs of therapy must be balanced against long-term benefits. Long-term costs of uncontrolled hypertension include those resulting from other cardiovascular diseases for which hypertension is a significant risk factor, involving the brain, kidneys and arterial system. Benefits from anti-hypertensive therapy are greater in older patients and in those with more severe blood pressure elevation. In those over 70 years old with a diastolic blood pressure between 100 and 104 mmHg, effective anti-hypertensive therapy has actually been demonstrated to result in a cost saving.