Ll the average cos t of care during the 12 month

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ll The average cos t of care during the 12 month study was not significantly different between the.wo grr · rp s (work site, $243; co mmunity, $211), However, the In cremental cost-effectiveness ratio of the worksite·treated groups ($5.63 PCI' mm Hg reduction ) was much lower th an the ba ~,e cost-e ff ec tivene ss ratio for the r<gular cue groups ($32.51 per mm Hg reduction). The st udy found that specially trained nurses were mere effec ~ live in achiev[,lg blood pressure goals with employees at the worksite (48.5 \0) in the first six months than was the pa· ~1c~t's f~miJy doctor (27.5%), based on random assignment to worksite or regul ar source of care. 12 An ot her INork place hypertension con trol program report ed ave rage patient co sts of $194.77 in 1 978, including drugs that accounted for 23.9 % of the total. 13 A number of theoretical models for assessi ng overall cost·to-benefit ratios for worksite hypertension programs have been advanced. Reasonable estimates ex ist for many key terms in the formula such as prevalence (by Jge and sex), cost of treatment, mortality rates, so me morbidity rates (heart attacks and strokes), rates of adherence, cost per disability day and per absenteeism day, Jnd even present value cost for heart attack and stroke. Howe ve r, several critical variables ca nnol be well est imated, particu- larly changes in absenteeism rates related to hyp ertension, how these rates change with control, and fraction of possible benefits actually realized from the program. None· theless, modeling of coqs and benefits for hypertension is further advanced than for any other risks addressed in industrial health promoti on programs. Some preliminary runs of a mod el developed by Hannan and Graham 14 sug· ge st a significant dollar benefit in excess of cos ts for most age/sex distributions found in worksite populations assum- ii'g adherence rates of 88%, fraction of benefits at 80%, at.senteeism days th at are translated into costs at 90% and the percentage reduction in disability days as a result of treatment at 25%. A smaller reduction in disability days swi ngs the analysis towards a net loss. Unfortun ately, the sensitivity of the net figure to small changes in critical variables makes it difficult to consider th e r es ult a5 more than a gross estimate. These analyses are conducted from the perspective of an employer and therefore do not include major benefit items, such as reduced suffering for the individual and family members, and the improveL quality of life, nor do they ~o nsider impacts on taxes, social sec urit y benefits and other economic effect s. The life insurance industry has pro vided financial ince n- li ves for effective blood pressure co ntr ol by reducing or eliminating the extra premiums hypertensives have to pay if they are under effective control. At le ast one major rein- surer, Lincoln Nation al Life, accepts treated blood pressure readings as the basi s for calculating premiums if the insured haS" been under treatment f{)r more than five years and if his blood pressure has been successfully lowered « ·150/ 96 or 160/94 mm Hg) .15
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  • Spring '12
  • fwsf
  • th e average, th ese programs, th ese program, al th prohssionals, th e work

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