P-445: Health care costs related to multi-drug treated hypertensives in the medicare population

Abstract

To identify costs related to managing multi-drug treated hypertension patients, an historical claims-based study was conducted. A random sample of 5% of the Medicare Fee-For-Service population was obtained from CMS as well as a managed care database of Medicare eligible lives. The claims from these databases included 1.9 million Medicare lives during 12 months (2001). In the Medicare managed care database claims were analyzed to identify patients with a hypertension diagnosis taking ≥ 3 hypertension drugs, including a diuretic (surrogate for refractory hypertension). Eight percent of the Medicare sample met these qualifications. Cardiovascular co-morbidities were identified in hypertensive patients using ICD-9 codes: renal disease (.77%), heart failure (2%), diabetes (2.9%), stroke (.55%) or heart disease (2.25%). Five percent of the Medicare population had at least one additional diagnosis and 3% did not have these diagnoses. Hypertension related charges and reimbursements were identified for hypertension patients with and without these co-morbidities and projected to the entire Medicare population (Table 1). The total Medicare population is estimated to be 39,900,000 in 2003. The co-morbidity health care costs for hypertension patients with ≥ 1 co-morbidity are shown in Table 1 by co-morbidity.

Table 1

Pts with 3 or > HTN Drugs	HTN Related Median $ Charges/Reimb	%/# Medicare Pts	Total $ HTN Charges/Reimb
HTN Only	$502/$251	3%/1197000	$600.9M/$300.4M
HTN with 1 or > co-morbidity	$1253/$506	5%/1995000	$2.50B/$1B
Co-morbidity	Co-morbidity Median $ Charges/Reimb	%/# Medicare Pts	Total Co-morbidity $ Charges/Reimb
Renal Disease	$1302/$572	.77%/307230	$400M/$175.7M
CHF	$4101/$1463	2%/798000	$3.27B/$1.17B
Diabetes	$1228/$559	2.9%/1157100	$1.42B/$648.8M
Stroke	$515/$285	.55%/219450	$113M/$62.5M
Heart Disease	$1101/$473	2.25%/897750	$988.4M/$424.6M

M = $Millions, B = $Billions.

Hypertensive patients on ≥ 3 hypertension drugs and ≥ 1 co-morbidity have significantly higher hypertension costs than patients with out co-morbidities. Hypertensive patients with heart failure have the highest total Medicare and the highest median costs.

Hypertension Costs, Hypertension Co-Morbidities, Hypertension Population Size