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HSR&D 2004 National Meeting Abstracts

1034. Economic Impact of Implementing Findings from the ALLHAT Study in a VISN
MITCHELL J Barnett, RPH, MS, Iowa City VAMC, PJ Kaboli, University of Iowa Roy J & Lucille A Carver College of Medicine and Iowa City VAMC, AA Bhattacharyya, Iowa City VAMC, CJ Franciscusa, Iowa City VAMC, RI Shorr, University of Tennessee College of Medicine, GE Rosenthal, University of Iowa Roy J & Lucille A Carver College of Medicine and Iowa City VAMC

Objectives: Estimate cost savings to VHA of implementing the ALLHAT recommendation that thiazides be first-line antihypertensive therapy.

Methods: 28,085 outpatients receiving treatment for hypertension in VISN 14 (IA, NE, western IL) in FY 2000 were identified using administrative and pharmacy databases. Per ALLHAT criteria, we excluded 6,213 patients < 55 years or with heart failure. We also excluded 6,685 patients with possible thiazide contraindications (benign prostatic hypertrophy, gout, chronic renal insufficiency) and 679 diabetics receiving sole therapy with ACE inhibitors, leaving 14,508 patients (mean age, 70 years; 97 % male). We estimated the savings of switching patients from calcium channel blockers (CCBs), ACE inhibitors, or alpha blockers to thiazides, using VA cost data. Other medication switches were not considered because of negligible cost differences.

Results: 4,961 (34.2%) patients were already on thiazides. Of the 9,547 patients not receiving thiazides, the mean number of antihypertensives was 1.9. The most common agents were ACE-inhibitors (52%), CCBs (48%), beta-blockers (47%), alpha-blockers (17%), and clonidine (4%). Switching all 4,537 patients on CCBs to thiazides would result in annual drug savings of $716,664. Switching the remaining (4,141) patients receiving ACE inhibitors or alpha-blockers to thiazides would yield additional savings of $285,426 (total savings, $1,002,090). Of hypertensives eligible for switch (31%), cost savings were $115 annually per patient.

Conclusions: Implementing ALLHAT recommendations in a VISN would yield substantial savings. These estimates do not include potential savings in patients <55 years or benefits from improved outcomes.

Impact: Extrapolating our findings througout VHA may yield savings of $32-45 million annually.