Analyses of cost effectiveness in the management of essential hypertension: What they can and what they do not teach us

There are approximately 50 million hypertensive individuals in the United States, and their treatment is often life-long. Most are asymptomatic, so the goal of treatment is to prevent complications, which often occur decades after the condition is detected. Although the management of hypertension is potentially very costly, it is now clear that antihypertensive therapy can substantially reduce cardiovascular mortality and morbidity. This constellation of an asymptomatic process with a very high prevalence capable of producing severe and potentially costly complications is precisely the circumstance under which cost effectiveness of therapy becomes an important consideration. Several such analyses have been performed, examining the question of which patients should be treated, what procedures should be used in their evaluation, and which therapeutic agents should be used. These studies high light important issues, but also illustrate the potential pitfalls and fallacies of such analyses, particularly when outcome data are unavailable or inadequate. This article reviews the literature concerning cost-effectiveness analyses in the management of hypertension and discusses the value of this approach.