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Cost-effectiveness of Antihypertensive Medication: Exploring Race and Sex Differences Using Data From the REasons for Geographic and Racial Differences in Stroke Study.

ABSTRACT: Antihypertensive medication decreases risk of cardiovascular disease (CVD) events in adults with hypertension. Although black adults have higher prevalence of hypertension and worse CVD outcomes compared with whites, limited attention has been given to the cost-effectiveness of antihypertensive medication for blacks.To compare the cost-effectiveness of antihypertensive medication treatment versus no-treatment in white and black adults.We constructed a State Transition Model to assess the costs and quality-adjusted life-years (QALYs) associated with either antihypertensive medication treatment or no-treatment using data from the REasons for Geographic and Racial Differences in Stroke (REGARDS) study and published literature. CVD events and health states considered in the model included stroke, coronary heart disease, heart failure, chronic kidney disease, and end-stage renal disease.White and black adults with hypertension in the United States, 45 years of age and above.Yearly risk of CVD was determined using REGARDS data and published literature. Antihypertensive medication costs were determined using Medicare claims. Event and health state costs were estimated from published literature. All costs were adjusted to 2012 US dollars. Effectiveness was assessed using QALYs.Antihypertensive medication treatment was cost-saving and increased QALYs compared with no-treatment for white men ($7387; 1.14 QALYs), white women ($7796; 0.89 QALYs), black men ($8400; 1.66 QALYs), and black women ($10,249; 1.79 QALYs).Antihypertensive medication treatment is cost-saving and increases QALYs for all groups considered in the model, particularly among black adults.

SUBMITTER: Tajeu GS

PROVIDER: S-EPMC5580679 | biostudies-literature | 2017 Jun

REPOSITORIES: biostudies-literature

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Cost-effectiveness of Antihypertensive Medication: Exploring Race and Sex Differences Using Data From the REasons for Geographic and Racial Differences in Stroke Study.

Tajeu Gabriel S GS Mennemeyer Stephen S Menachemi Nir N Weech-Maldonado Robert R Kilgore Meredith M

Medical care 20170601 6

<h4>Background</h4>Antihypertensive medication decreases risk of cardiovascular disease (CVD) events in adults with hypertension. Although black adults have higher prevalence of hypertension and worse CVD outcomes compared with whites, limited attention has been given to the cost-effectiveness of antihypertensive medication for blacks.<h4>Objective</h4>To compare the cost-effectiveness of antihypertensive medication treatment versus no-treatment in white and black adults.<h4>Research design</h4> ...[more]

PMID: 28333708

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Project description:Study objectivesTo examine the cross-sectional association between obstructive sleep apnea (OSA) risk and atrial fibrillation (AF) in the REasons for Geographic And Racial Differences in Stroke (REGARDS), a cohort of black and white adults.MethodsUsing REGARDS data from subjects recruited between 2003-2007, we assessed 20,351 participants for OSA status. High OSA risk was determined if the participant met at least two criteria from the Berlin Sleep Questionnaire (persistent snoring, frequent sleepiness, high blood pressure, or obesity). AF was defined as a self-reported history of a previous physician diagnosis or presence of AF on electrocardiogram. Logistic regression was used to determine odds ratio and 95% confidence interval for the association between OSA status and AF with subgroup analysis to examine effect modification by age, race, sex, and geographical region.ResultsThe prevalence of AF was 7% (n = 1,079/14,992) and 9% (n = 482/5,359) in participants at low and high risk of OSA, respectively (P < .0001). Persons at high risk of OSA had greater prevalence of diabetes and stroke history, and were more likely to be obese and taking sleep medications. In a multivariable analysis adjusted for demographics, cardiovascular risk factors, and potential confounders, high risk for OSA was associated with an increased odds of AF compared to low risk for OSA (odds ratio = 1.27, 95% confidence interval = 1.13, 1.44). This association differed significantly only by race (P for interaction = .0003). For blacks, there was a significant 58% increase in odds of AF in participants at high risk versus low risk of OSA, compared to a nonsignificant 12% increase in odds in whites. We were limited by self-reported variables, inability to adjust for obesity, and the cross-sectional nature of our study.ConclusionsHigh risk of OSA is associated with prevalent AF among blacks but not whites.CommentaryA commentary on this article appears in this issue on page 1459.

Project description:BackgroundPrior work has identified disparities in the quality and outcomes of healthcare across socioeconomic subgroups. Medication use may be subject to similar disparities.ObjectiveTo assess the association between demographic and socioeconomic factors (gender, age, race, income, education, and rural or urban residence) and appropriateness of medication use.MethodsUS adults aged ≥45 years (n = 26,798) from the REasons for Geographic And Racial Differences in Stroke (REGARDS) study were included in the analyses, of which 13,623 participants aged ≥65 years (recruited 2003-2007). Potentially inappropriate medication (PIM) use in older adults and drug-drug interactions (DDIs) were identified through 2015 Beers Criteria and clinically significant drug interactions list by Ament et al., respectively as measures of medication appropriateness. Multivariable logistic regression was used to assess the association of disparity parameters with PIM use and DDIs. Interactions between race and other disparity variables were investigated.ResultsApproximately 87% of the participants aged ≥65 years used at least one drug listed in the Beers Criteria, and 3.8% of all participants used two or more drugs with DDIs. Significant gender-race interaction across prescription-only drug users revealed that white females compared with white males (OR = 1.33, 95% CI 1.20-1.48) and black males compared with white males (OR = 1.60, 95% CI 1.41-1.82) were more likely to receive PIM. Individuals with lower income and education also were more likely to use PIM in this sub-group. Females were less likely than males (female vs. male: OR = 0.55, 95% CI 0.48-0.63) and individuals resided in small rural areas as opposed to urban areas (small rural vs. urban: OR = 1.37, 95% CI 1.07-1.76) were more likely to have DDIs.ConclusionDemographic and socioeconomic disparities in PIM use and DDIs exist. Future studies should seek to better understand factors contributing to the disparities in order to guide development of interventions.

Dataset Information

Cost-effectiveness of Antihypertensive Medication: Exploring Race and Sex Differences Using Data From the REasons for Geographic and Racial Differences in Stroke Study.

Publications

Cost-effectiveness of Antihypertensive Medication: Exploring Race and Sex Differences Using Data From the REasons for Geographic and Racial Differences in Stroke Study.

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