• DOI:10.1111/j.1749-6632.1978.tb25625.x
• Corpus ID: 46598377

ECONOMIC CONSIDERATIONS IN THE MANAGEMENT OF MILD HYPERTENSION

@article{Weinstein1978ECONOMICCI,
  title={ECONOMIC CONSIDERATIONS IN THE MANAGEMENT OF MILD HYPERTENSION},
  author={Milton C. Weinstein and William B. Stason},
  journal={Annals of the New York Academy of Sciences},
  year={1978},
  volume={304}
}

• M. Weinstein, W. Stason
• Published 1 March 1978
• Medicine, Political Science
• Annals of the New York Academy of Sciences

As health care costs relentlessly spiral upward. it becomes increasingly apparent that the limited resources for health care must be allocated prudently. It is no longer sufficient to judge the merits of a health program, such as the treatment of mild hypertension, solely on the basis of the health benefits it can provide; these benefits must be considered in relation to the resource costs. On the other hand, we must never let cost alone deter us from embarking upon a health program that can significantly extend life or improve the quality of life. A reasonable societal goal in evaluating health programs would be to place competing uses of health resources in a scheme of priorities based on costeffectiveness, so that these resources might be allocated so as to achieve the greatest possible health benefits.’ Of course, the objectives of the individual patient and his physician may differ from those of society. Our purpose here is not to analyze these differences in perspective, but instead to assume the societal perspective in relating the cost and the potential effectiveness of a national effort to treat mild hypertension in the United States. There are many methods for measuring and comparing the costs and benefits of health programs or practices. One approach, the benefit-cost approach, is to attempt to measure all outcomes, including changes in longevity and morbidity, in economic terms. Thus, the cost of a premature death, or of disability due to a stroke or a myocardial infarction, might be valued in terms of the dollar value of the individual’s lost productivity, as measured by lost earnings.? Benefits of antihypertensive treatment would then include the dollar “values” of these productive years of life, and from these would be subtracted the costs of treatment to derive an estimate of the net societal benefit for the program in question. Problems arise in this type of analysis, however, in assigning a dollar value to a year of life or a day of disability. For example, should the value of a year of life vary with the earnings or potential earnings of an individual, or should all lives of a given quality be valued equally? We believe that it is less important to seek an arbitrary economic value for “life-years” or “work days” than to derive a measure of the amount of health benefits received, in their own terms, for a given investment of health care resources. Therefore, we have chosen the framework of cost-effectiveness analysis.’. 3. .I In this approach, a ratio is developed which compares net health care costs, measured in dollars, to net health effectiveness, usually measured in lives saved or life-years gained. We use “quality-adjusted life-years” as the measure of effectiveness so that changes in survival and morbidity can be incorporated into a single measure that reflects the tradeoffs between them. The ratio of net costs to net effectiveness, expressed as dollars per year of increased quality-adjusted