To quantify the costs of hypertension diagnosis and treatment in Australia, particularly in primary care, including general practices and pharmacies.
Economic analysis; analysis of Pharmaceutical Benefits Scheme (PBS) and Medicare Benefits Schedule (MBS) data.
Australia, 2012–22.
Estimated expenditure on hypertension care (adjusted to 2022 Australian dollars), overall and by expenditure type (general practice consultations, medications), cost bearer (PBS, MBS, patient out-of-pocket costs), and broad expenditure category (medication costs, pharmacy costs, general practice consultations, ambulatory blood pressure monitoring).
During 2012–22, estimated total expenditure for the diagnosis and treatment of hypertension in Australia was $12.2 billion: $7.3 billion (60%) was borne by the MBS and PBS, $4.9 billion (40%) by patients as out-of-pocket costs. During 2021–22, an estimated $1.2 billion was spent on the management of hypertension; the three main cost components were pharmacy-related costs (administration and handling fees, dispensing fees, electronic prescription fees: $611.1 million, 50.8%), general practice consultations ($342.7 million, 28.5%), and blood pressure-lowering medications (manufacturer and wholesale costs: $244.3 million, 20.3%).
During 2012–22, about 40% of the cost of managing hypertension in Australia was borne directly by patients (about $494 million per year). Important changes to pharmacy supply and payment policies were introduced in 2023, but further efforts may be needed to reduce treatment costs for patients. These changes are particularly important if the hypertension control rate is to be substantially improved in Australia, given the large numbers of undertreated and untreated people with hypertension.
To the Editor: We read with interest the above case report.1 Although it was mainly focused on the clinical presentation and microbiology of hypervirulent Klebsiella pneumonia, we are interested in other features of the case report.
We believe that the title is misleading as there were no radiological features of emphysematous pyelonephritis (gas in the collecting system, or inside or outside Gerota's fascia) but there was impressive emphysematous cystitis. Emphysematous cystitis is heavily associated with renal glycosuria, enabling the enteric organisms to ferment glucose to carbon dioxide and hydrogen in the bladder tissue. The recent increase in the use of sodium–glucose cotransporter type 2 (SGLT2) inhibitors to treat diabetes may see a significant rise in this complication. It is not stated whether the patient was being treated with SGLT2 inhibitors. It is important to mention that the mortality rates for emphysematous cystitis (3–12%) significantly differ from emphysematous pyelonephritis (14–20%).2
The portal of entry of hypervirulent K. pneumoniae is uncertain but most likely is faecal–oral. The prevalence of K. pneumoniae carriage is higher in the Asian population (60–70%) when compared with people of European descent (5–35%) due to differences in the intestinal microbiome.3 It is probable that the same applies for hypervirulent K. pneumoniae.
The bloodborne spread of enteric organisms from the gastrointestinal tract is dependent on both host factors (diabetes, alcohol consumption and immunosuppression) and local factors (eg, diet, population ethnicity, climate). A recent case of emphysematous cystitis and enterococcal meningitis treated by one of the authors lead to the discovery of strongyloidiasis as an underlying cause. It is well known that strongyloidiasis can be asymptomatic and that it is hyperendemic in South-East Asia.4 Strongyloides spp can easily penetrate the intestinal wall and translocate enteric organisms into the portal circulation.5 It would be of interest to know whether Ong and colleagues performed stool analysis or serology for Strongyloides spp.
No relevant disclosures.
In reply: We thank Bowyer and Prentice for their input1 regarding our article2 on this interesting and complex topic.
We agree with the definition of emphysematous pyelonephritis and emphysematous cystitis as described by Bowyer and Prentice. There was indeed gas evident within our patient's left renal collecting system, as shown on a computed tomography scan, which was not included in our published article as we felt that the other published images would be of more interest to readers.
We agree that sodium–glucose cotransporter type 2 (SGLT2) inhibitors cause glycosuria and have been implicated in an increased risk of urinary tract infections.3, 4 Our patient had been taking an SGLT2 inhibitor, which was ceased during his first admission.
The occasional association of intestinal strongyloidiasis with gram-negative sepsis and, in particular, gram-negative bacillary meningitis, is well recognised. However, strongyloidiasis was not suspected in our patient, and diagnostic tests for this pathogen were not performed.
No relevant disclosures.
Introduction: This consensus statement recommends eight high-level trackable policy actions most likely to significantly improve health and wellbeing for children and young people by 2030. These policy actions include an overarching policy action and span seven interconnected domains that need to be adequately resourced for every young person to thrive: Material basics; Valued, loved and safe; Positive sense of identity and culture; Learning and employment pathways; Healthy; Participating; and Environments and sustainable futures.
Main recommendations: Provide financial support to invest in families with young children and address poverty and material deprivation in the first 2000 days of life. Establish a national investment fund to provide sustained, culturally relevant, maternal and child health and development home visiting services for the first 2000 days of life for all children facing structural disadvantage and/or adversity. Implement a dedicated funding model for Aboriginal and Torres Strait Islander community-controlled early years services across the country to ensure these services are fully resourced to provide quality early learning and integrated services grounded in culture and community. Properly fund public schools, starting by providing full and accountable Schooling Resource Standard funding for all schools, with immediate effect for schools in communities facing structural disadvantage. Establish legislation and regulation to protect children and young people aged under 18 years from the marketing of unhealthy and harmful products. Amend the electoral act to extend the compulsory voting age to 16 years. Legislate an immediate end to all new fossil fuel projects in Australia. Establish a federal Future Generations Commission with legislated powers to protect the interests of future generations.
Changes in approach as a result of this statement: Together, these achievable evidence-based policies would significantly improve children and young people's health and wellbeing by 2030, build a strong foundation for future generations, and provide co-benefits for all generations and society.
Scabies is the most common neglected tropical disease with cutaneous manifestations, disproportionately affecting socially disadvantaged populations living in overcrowded settings. Scabies infestation is characterised by a generalised intractable pruritus, and is often complicated by secondary bacterial infection, which can lead to a range of complications. Scabies is a clinical diagnosis and requires an adequate degree of suspicion. The use of dermoscopy may improve diagnostic accuracy. In Australia, the first-line treatment recommended for scabies is topical permethrin 5% cream, applied to the whole body and repeated in one week. Oral ivermectin is subsidised by the Pharmaceutical Benefits Scheme with streamlined authority for patients who have completed and failed treatment with topical therapy, have a contraindication to topical treatment or have crusted scabies. Early identification and prompt initiation of treatment is key to minimise the disease burden of scabies.
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