Economics of antihypertensive therapy in the elderly

Because of the high incidence of morbidity and mortality associated with hy pertension in the elderly, the treatment of hypertension in this patient gr oup must involve consideration of clinical, humanistic and economic outcome s. The most frequently used method of pharmacoeconomic analysis for antihyp ertensive therapy involves cost-effectiveness analysis, although several ot her methods are available. Current evidence reveals a trend toward cost eff ectiveness of antihypertensive treatment in elderly patients. However, thes e formal analyses are limited by the need for extrapolation of data regardi ng efficacy and level of risk from epidemiological and randomised trials, i nformation which is often lacking. To incorporate economic factors into cli nical decision making, other measures of economic impact should be explored . The economic impact of antihypertensive therapy is affected by the level of risk for the patient and the efficacy of the treatment. Data indicate that the risk of morbidity and mortality related to hypertension increases with age and that current antihypertensive drugs reduce this risk. When choosin g an antihypertensive agent, the following parameters should be considered: acquisition cost, likelihood of adverse effects and other determinants of treatment adherence, and individual predictors of response. The economic ou tcomes will be maximised if prudent drug selection is supplemented by appro priate diagnostic and classification procedures and reduction of cardiovasc ular risk factors other than hypertension. The accumulation of data address ing the risks and benefits of therapy fur the very old and the comparative efficacy of newer antihypertensive therapies will further clarify the decis ion-making process.