Hypertension-Associated Medical Expenditures Among Privately Insured US Individuals Aged 18 to 64 Years in 2021

OBJECTIVES: To estimate hypertension-associated total and out-of-pocket (OOP) medical expenditures among US adults overall and by sex and age group.

METHODS: In this cross-sectional study, we used IQVIA’s Ambulatory Electronic Medical Records (AEMR)-US dataset linked with IQVIA’s PharMetrics Plus Claims database for continuously insured individuals from January 01 through December 31, 2021. Included individuals, aged 18–64 years, were privately insured, with at least one blood pressure measurement in 2020–2021. Adults with hypertension were identified by a three-criteria e-phenotype (≥1 diagnosis code, ≥ 2 blood pressure measurements of ≥140/90 mmHg, or ≥1 antihypertensive medication during the study period). Annual total expenditures were estimated using generalized linear model (GLM) regression with gamma distribution and log-link function. OOP expenditures were estimated using a two-part model that included logistic regression and GLM regression. Propensity-score based overlap weighting was used to adjust for measured confounders wherein study sample was balanced by hypertension status on all covariates, including sex, age group, race, weight category and its interaction with hypertension.

RESULTS: The sample included 393,018 adults; 223,267 (57%) were female, and the mean (SD) age was 46 (13) years. Compared to those without hypertension, total and OOP expenditures were higher for adults with hypertension by $2,926 (95% CI=$2,681–$3,170) and $328 (95% CI=$300–$355), respectively. Adults with hypertension had higher total inpatient ($3,272; 95% CI=$1,458–$5,086), outpatient ($2,189; 95% CI=$2,009–$2,369), and pharmacy ($1,024; 95% CI=$833–$1,215) expenditures when compared to those without hypertension. Compared to patients without hypertension, total expenditures for those with hypertension were higher by $3,242 (95% CI= $2,915–$3,569) among women and by $2,521 (95% CI=$2,139–$2,904) among men.

CONCLUSIONS: Findings of this study indicate care-seeking adults with hypertension had higher medical expenditures, including higher inpatient and OOP expenditures, than those without hypertension. The results may help estimate the economic burden of hypertension and could inform efforts to prevent and control hypertension.