(37) Healthcare Costs and Delays in Treatment Escalation in Hypertension Patients in the United States: Results from the BREAKTHROUGH Real-World Study

Background: : According to 2017 ACC/AHA guidelines, patients with elevated blood pressure are recommended to have their hypertension treatments reassessed every 3 or 6 months.

Objective: : The purpose of this study was to describe the treatment journey of individuals with hypertension in the United States, characterizing healthcare costs during the first four antihypertensive medication lines of therapy (LOTs) and describing delays in treatment escalation.

Methods: : This retrospective analysis used claims from the MORE2 Registry® and 100% Medicare Fee-for-Service (MFFS) database from 1/1/2019 to 12/31/2022 (MFFS), or 3/31/2024 (MORE2). Patients had ≥1 primary inpatient or ≥ 2 outpatient claims with a hypertension diagnosis (index date), were ≥18 years of age, and had ≥12 months of continuous enrollment prior to and ≥30 days following the index date. Antihypertensive LOTs were identified as the number of unique classes, beginning with the first class(es) prescribed within 28 days of the index date or the start date of LOT and continuing until a new treatment was initiated or all treatments were discontinued. Endpoints included all-cause medical costs, evaluated during each LOT and reported per patient per month (PPPM), and delayed treatment escalation was defined as progression from first to second LOT after 90 days.

Results: : In total, 19,060,253 patients were identified. Mean (SD) age was 66.8 (15.3) years, and the majority were female (55.3%) and MFFS beneficiaries (61.0%). Of those identified, 89.6% received a first LOT; 51.0% received a second after a mean (SD) of 449.3 [452.5] days after first LOT. Of patients progressing from first to second LOT, 60.5% escalated after 90 days. PPPM mean (SD) medical costs were $1,866 ($8,371) in the first LOT and peaked at $2,591 ($14,635) in the second LOT, representing a 38.9% increase from the first LOT. Among Medicare patients, PPPM mean (SD) medical costs increased by 22.8% from $2,307 ($6,750) in the first LOT to $2,833 ($11,495) in the second LOT, while among commercial patients, medical costs rose by 31.8% from $1,136 ($7,730) in the first LOT to $1,497 ($22,971) in the second LOT.

Conclusions: : Most patients experienced treatment escalation more than 90 days after initial therapy, suggesting potential delays in treatment intensification relative to guideline recommendations. Additionally, all-cause medical costs increased after the first LOT, underscoring the increased economic burden of hypertension disease progression. These findings emphasize the need for timely and effective hypertension management.

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