HOSPITALIZATION COSTS ASSOCIATED WITH HYPERTENSION AS A SECONDARY DIAGNOSIS AMONG INSURED PATIENTS AGED 18-64 YEARS - MARKETSCAN DATA 2005

Purpose: To estimate hospitalization costs associated with hypertension (ICD-9: 401-405) as a secondary diagnosis among insured adults 18-64 years.

Method: Using 2005 MarketScan CCAE in-patient admissions, we selected the sample patients with total hospital costs within the 1st and the 99th percentile for this analysis (N=455,944 patients, 18% of them with hypertension as a secondary diagnosis).  We categorized and analyzed by four population groups: 1) entire selected patients; 2) patients with a primary diagnosis of ischemic heart disease (ICD-9: 410-414); 3) patients with a primary diagnosis of cerebrovascular disease (ICD-9:430-438); and 4) patients without ischemic heart or cerebrovascular disease as a primary diagnosis.  Propensity score matching was conducted to control possible bias in cost estimates due to sample selections.  The incremental costs of hypertension were estimated by a regression model on the matched populations, controlling for age, gender, length of hospital stays, Charlson Comorbidity Index, residence region, and urbanization.

Result: For patients with hypertension as a secondary diagnosis, the annual hospitalization costs per patient were $21,094, of which $2,734 (13%; p<0.01) was associated with hypertension.  For patients with a primary diagnosis of ischemic heart disease, cerebrovascular disease, and without ischemic heart disease or cerebrovascular disease, the costs were $31,106, $17,298, and $18,692 in the hypertensive group, respectively; of which the hypertension associated costs were $3,540 (11.4%; p<0.01), $1,133 (6.5%; p<0.01), and $2,254 (12.1%; p<0.01), respectively.

Conclusion: Hypertension associated hospitalization costs are high for the insured patients aged 18-64 years with hypertension as a secondary diagnosis.  This suggests a need to develop cost-effective programs to prevent, manage, and control hypertension to reduce serious and costly complications.  Additionally, allocating the costs of hypertension in patients with a non-hypertension primary diagnosis is important in order to correctly derive the economic burden of hypertension.