HIPERTENSÃO ARTERIAL EM PORTUGAL – O CUSTO DO CONTROLO

Abstract

Introduction: Arterial hypertension (AHT) has an increasing worldwide prevalence. In Portugal, it’s prevalence is of 36%, being AHT the main cause of death. AHT control is the best way to prent its health outcomes. The aim of this study was to analyze the cost of treatment of controlled hypertension, understanding the differences between patients with and without control. In addition, regional asymmetries were assessed in terms of compliance with the ideal scenario: the best control of the disease, at the lowest possible cost, in the Primary Health Care environment.

Methods: An observational study was made collecting public data on the “Bilhete de Identidade dos Cuidados de Saúde Primários” platform. Two indicators were compared: 352 - Cost of treatment for patients with arterial hypertension; 353 - Cost of treatment for patients with controlled arterial hypertension. The universe of the Portuguese people attended in the National Health Service in Portugal was studied by two indicators in December 2017 and 2018, and a representative randomized sample of units for each Portuguese health region. The indicators are based on the value of retail prices of the prescribed anti-AHT medicines prescribed and not on the purchase value. Data distribution being normal, Student’s T test and ANOVA were applied, with statistical significance defined as p<0,001.

Results: A significant difference between the two indicators, with higher values for the control situation was found in the years of 2017 and 2018. The cost of therapy in a patient with controlled hypertension is higher than in the uncontrolled situation. In 2017, there was no significant difference between regions. However, in 2018, a highest costs of AHT control in Alentejo and Centro region was found as opposed to the less costly regions of Norte and Lisboa e Vale do Tejo.

Discussion: Control of AHT is more costly, possibly because non-pharmacological measures are not yet sufficiently valued and implemented in society. Higher cost of prescription may be due to socioeconomic differences that can be a barrier to the purchase of medication. Regional differences can be explained by contrasts in education, economic power and distribution of access and type of primary health care.

Conclusion: The cost of medications for controlled ATH is significantly higher than that of uncontrolled hypertension. Regional differences should be addressed by the competent authorities in order to modify them.