Cost-Effective Hypertension Management: Comparison of Drug Therapies With an Alternative Program

Publication: The American Journal of Managed Care, Vol. 2, pp. 427-437, 1996.

Authors: Robert E. Herron, PhD,* Robert H. Schneider, MD,** Joseph V. Mandarino, PhD,  Charles N. Alexander, PhD,** and Kenneth G. Walton, PhD.  

Conducted at **Institute of Science, Technology and Public Policy, and **Center for Health and Aging Studies, Department of Physiological and Biological Sciences, and Department of Management, and Departments of Chemistry and Physiology, Maharishi University of Management, Fairfield, IA

Summary

The competitive nature of managed care organizations demands that providers seek cost-effective ways to maintain the health of their clients. As an approach to reducing cardiovascular morbidity and mortality, antihypertensive medication is costly, has adverse side effects, and has questionable value in reducing coronary heart disease. This report evaluates a behavioral stress-reduction method as an option to pharmaceutical treatment. Randomized studies indicate that the Transcendental Meditation® (TM) technique reduces mild hypertension (the predominant form of hypertension) as effectively as do drug therapies. A cost-effectiveness comparison in 1996 dollars was conducted among five standard antihypertensive medications and the TM technique over a simulated 20-year treatment period.

According to present value analysis of treatment payments, the TM technique had the lowest present value cost, and thus appeared to be the most attractive alternative. The estimated average cost of antihypertensive drug treatment ranged from $375 per year for hydrochlorothiazide to $1,051 per year for propranolol hydrochloride, whereas the estimated average cost of treatment with the TM technique was $286 per year. When combined with results of controlled trials documenting the effectiveness of the TM technique in reducing high blood pressure, decreasing morbidity and mortality, and improving the quality of life, the present comparison suggests that this nonpharmacologic procedure may be safely used as a cost-effective treatment of hypertension in the managed care setting.

Transcendental Meditation® Program Study #2

Title
The Impact of the Transcendental Meditation Program on Government Payments to Physicians in Quebec: An Update

Publication
American Journal of Health Promotion, Vol. 14, No. 5, pp. 284-291, 2000.

Authors
Robert E. Herron* and Stephen L. Hillis**

Conducted at
* Department of Management and Public Administration, Maharishi University of Management, Fairfield, IA 52557
** Department of Statistics and Actuarial Science, University of Iowa, Iowa City, IA

Summary

This study expands upon a previous study conducted by the authors to analyze whether practice of the Transcendental Meditation (TM) technique affected government payments to physicians in Quebec, Canada. The present study includes data on an additional 741 practitioners of the TM technique (for a total of 1418 TM subjects) and a comparison subject for each TM practitioner, and extends the time period three additional years. This retrospective, longitudinal study compared data on government payments to physicians for treating 1418 health insurance enrollees in Quebec who practiced TM and 1418 comparison subjects who did not practice TM. Data for pre-intervention and post-intervention periods over a time period of 14 years was analyzed. The TM subjects had practiced TM for an average of 6.7 years and participated in the study by filling out a questionnaire. They were considered a convenience sample since they were self-selected, the number of questionnaires distributed was not known, and the number of possible respondents was not known. The comparison group for this study was randomly selected by the Quebec health insurance agency, matching each TM subject with a comparison subject having the same age, gender, and region in which they lived. The total number of study subjects was 2836, including 1408 men and 1428 women, with an average age of 38 years. The subjects' annual physician expenses for the years 1981-1994 were adjusted for inflation and analyzed in constant 1992 Canadian dollars. For the preintervention period (before subjects started the TM technique), the yearly rate of increase in payments to physicians was not significantly different between the TM and comparison groups. For the post-intervention period (after the subjects started TM), the yearly payments to physicians for the comparison group increased to levels that were higher than the preintervention levels for this group, increasing up to 11.73% annually over a six-year period. In the TM group however, the yearly payments decreased 1% to 2% annually in the post-intervention period, resulting in a significant mean annual difference of 13.78% (p=0.0017), compared to the non-TM group. These data suggest that practice of the TM technique reduced payments to physicians between 5% and 13% per year over a six-year period, compared to the control group. This type of reduction in medical expenditures could result in billions of dollars saved by governments and private health insurance companies in nations experiencing rapidly rising health care costs.