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Am J Manag Care. 2003 Aug;9(8):529-36.

Economics of suboptimal drug use: cost-savings of using JNC-recommended medications for management of uncomplicated essential hypertension.

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  • 1Department of Health Services Research and Management, Texas Tech University Health Sciences Center, School of Medicine, Lubbock, Tex 79430, USA.



To quantify potential cost-savings associated with better compliance with the guidelines of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure UNC V) and to determine whether suboptimal utilization of medications is associated with higher costs for other health services.


Secondary data analysis using the Medical Expenditure Panel Survey (MEPS) conducted by the Agency for Healthcare Research and Quality and the National Center for Health Statistics. A complex sampling design was used to provide nationally representative estimates.


From interviews with a population-based and nationally representative sample of 22 601 individuals, 1588 patients with essential hypertension without other comorbid cardiovascular conditions were selected, representing 19.6 million patients in the United States in 1996. All medical treatments for essential hypertension in 1996 were extracted from the MEPS. Using the JNC V guidelines, prescriptions used in treating essential hypertension were categorized into first-line drugs (diuretics and beta-blockers), second-line drugs (calcium-channel blockers and angiotensin-converting enzyme inhibitors), and third-line (nonrecommended) drugs. Nonprescription expenditures were calculated. Multivariate analyses were performed to determine whether use of the first-line drugs was associated with cost-savings.


Compliance rate with the JNC guidelines was low. About 36%, 67%, and 87% of patients in the nation received first-, second-, and third-line drugs, respectively, at some point during 1996. Prescription expenditure constituted more than 67% of the total expenditures for treating essential hypertension. The use of first-line drugs (vs second-line drugs) was associated with expenditures that were dollar 2.6 billion to dollar 3.2 billion lower.


Compliance with the JNC guidelines for treating essential hypertension may reduce the costs of prescriptions and other medical services. Raising awareness of the JNC guidelines is crucial to achieve cost effectiveness in choosing treatment alternatives.

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