Advertisement

Economics of Team-based Care in Controlling Blood Pressure

A Community Guide Systematic Review

      Context

      High blood pressure is an important risk factor for cardiovascular disease and stroke, the leading cause of death in the U.S., and a substantial national burden through lost productivity and medical care. A recent Community Guide systematic review found strong evidence of effectiveness of team-based care in improving blood pressure control. The objective of the present review is to determine from the economic literature whether team-based care for blood pressure control is cost beneficial or cost effective.

      Evidence acquisition

      Electronic databases of papers published January 1980–May 2012 were searched to find economic evaluations of team-based care interventions to improve blood pressure outcomes, yielding 31 studies for inclusion.

      Evidence synthesis

      In analyses conducted in 2012, intervention cost, healthcare cost averted, benefit-to-cost ratios, and cost effectiveness were abstracted from the studies. The quality of estimates for intervention and healthcare cost from each study were assessed using three elements: intervention focus on blood pressure control, incremental estimates in the intervention group relative to a control group, and inclusion of major cost-driving elements in estimates. Intervention cost per unit reduction in systolic blood pressure was converted to lifetime intervention cost per quality-adjusted life-year (QALY) saved using algorithms from published trials.

      Conclusions

      Team-based care to improve blood pressure control is cost effective based on evidence that 26 of 28 estimates of $/QALY gained from ten studies were below a conservative threshold of $50,000. This finding is salient to recent U.S. healthcare reforms and coordinated patient-centered care through formation of Accountable Care Organizations.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Preventive Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Heidenreich P.A.
        • Trogdon J.G.
        • Khavjou O.A.
        • et al.
        Forecasting the future of cardiovascular disease in the United States: a policy statement from the American Heart Association.
        Circulation. 2011; 123: 933-944https://doi.org/10.1161/CIR.0b013e31820a55f5
        • Go A.S.
        • Mozaffarian D.
        • Roger V.L.
        • et al.
        Heart disease and stroke statistics—2014 update. A report from the American Heart Association.
        Circulation. 2014; 129: e28-e292https://doi.org/10.1161/01.cir.0000441139.02102.80
        • Community Preventive Services Task Force
        Team-based care to improve blood pressure control. Recommendation of the Community Preventive Services Task Force.
        Am J Prev Med. 2014; 47: 100-102https://doi.org/10.1016/j.amepre.2014.03.003
        • Proia K.K.
        • Thota A.B.
        • Njie G.J.
        • et al.
        Team-based care and improved blood pressure control: a Community Guide systematic review.
        Am J Prev Med. 2014; 47: 86-99https://doi.org/10.1016/j.amepre.2014.03.004
        • Eichler H.-G.
        • Kong S.X.
        • Gerth W.C.
        • Mavros P.
        • Jönsson B.
        Use of cost-effectiveness analysis in health-care resource allocation decision-making: how are cost-effectiveness thresholds expected to emerge?.
        Value Health. 2004; 7: 518-528https://doi.org/10.1111/j.1524-4733.2004.75003.x
        • Miller G.
        • Cohen J.T.
        • Roehrig C.
        Cost-effectiveness of cardiovascular disease spending.
        J Am Coll Cardiol. 2012; 60: 2123-2124https://doi.org/10.1016/j.jacc.2012.02.095
        • Mason J.M.
        • Freemantle N.
        • Gibson J.M.
        • New J.P.
        Specialist nurse-led clinics to improve control of hypertension and hyperlipidemia in diabetes.
        Diabetes Care. 2005; 28: 40https://doi.org/10.2337/diacare.28.1.40
        • McEwan P.
        • Peters J.R.
        • Bergenheim K.
        • Currie C.J.
        Evaluation of the costs and outcomes from changes in risk factors in type 2 diabetes using the Cardiff stochastic simulation cost-utility model (DiabForecaster).
        Curr Med Res Opin. 2005; 22: 121-129https://doi.org/10.1185/030079906X80350
        • UK Prospective Diabetes Study Group
        Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38.
        BMJ. 1998; 317: 703-713https://doi.org/10.1136/bmj.317.7160.703
        • Anderson K.M.
        • Odell P.M.
        • Wilson P.W.
        • Kannel W.B.
        Cardiovascular disease risk profiles.
        Am Heart J. 1991; 121: 293-298https://doi.org/10.1016/0002-8703(91)90861-B
        • Wilson P.W.
        • D’Agostino R.B.
        • Levy D.
        • Belanger A.M.
        • Silbershatz H.
        • Kannel W.B.
        Prediction of coronary heart disease using risk factor categories.
        Circulation. 1998; 97: 1837-1847https://doi.org/10.1161/01.CIR.97.18.1837
        • Wolf P.A.
        • D’Agostino R.B.
        • Belanger A.J.
        • Kannel W.B.
        Probability of stroke: a risk profile from the Framingham Study.
        Stroke. 1991; 22: 312-318https://doi.org/10.1161/01.STR.22.3.312
        • CDC Diabetes Cost-effectiveness Group
        Cost-effectiveness of intensive glycemic control, intensified hypertension control, and serum cholesterol level reduction for type 2 diabetes.
        JAMA. 2002; 287: 2542https://doi.org/10.1001/jama.287.19.2542
        • Eastman R.C.
        • Javitt J.C.
        • Herman W.H.
        • et al.
        Model of complications of NIDDM: I. Model construction and assumptions.
        Diabetes Care. 1997; 20: 725-734https://doi.org/10.2337/diacare.20.5.725
        • Kothari V.
        • Stevens R.J.
        • Adler A.I.
        • et al.
        UKPDS 60 risk of stroke in type 2 diabetes estimated by the UK Prospective Diabetes Study risk engine.
        Stroke. 2002; 33: 1776-1781https://doi.org/10.1161/01.STR.0000020091.07144.C7
        • Stevens R.J.
        • Kothari V.
        • Adler A.I.
        • Stratton I.M.
        • Holman R.R.
        • United Kingdom Prospective Diabetes Study Group
        The UKPDS risk engine: a model for the risk of coronary heart disease in Type II diabetes (UKPDS 56).
        Clin Sci. 2001; 101: 671-679https://doi.org/10.1042/CS20000335
        • Currie C.J.
        • McEwan P.
        • Peters J.R.
        • Patel T.C.
        • Dixon S.
        The routine collation of health outcomes data from hospital treated subjects in the Health Outcomes Data Repository (HODaR): descriptive analysis from the first 20,000 subjects.
        Value Health. 2005; 8: 581-590https://doi.org/10.1111/j.1524-4733.2005.00046.x
      1. World Bank Lending Groups. 2010. data.worldbank.org/about/country-and-lending-groups.

        • Cote I.
        • Gregoire J.P.
        • Moisan J.
        • Chabot I.
        • Lacroix G.
        A pharmacy-based health promotion programme in hypertension: cost-benefit analysis.
        Pharmacoeconomics. 2003; 21: 415-428https://doi.org/10.2165/00019053-200321060-00005
        • Artinian N.T.
        • Washington O.G.
        • Templin T.N.
        Effects of home telemonitoring and community-based monitoring on blood pressure control in urban African Americans: a pilot study.
        Heart Lung. 2001; 30: 191-199https://doi.org/10.1067/mhl.2001.112684
        • Bertera E.M.
        • Bertera R.L.
        The cost-effectiveness of telephone vs clinic counseling for hypertensive patients: a pilot study.
        Am J Public Health. 1981; 71: 626https://doi.org/10.2105/AJPH.71.6.626
        • Bosworth H.B.
        • Olsen M.K.
        • Grubber J.M.
        • et al.
        Two self-management interventions to improve hypertension control.
        Ann Intern Med. 2009; 151: 687https://doi.org/10.7326/0000605-200911170-00148
        • Bosworth H.B.
        • Powers B.J.
        • Olsen M.K.
        • et al.
        Home blood pressure management and improved blood pressure control: results from a randomized controlled trial.
        Arch Intern Med. 2011; 171: 1173https://doi.org/10.1001/archinternmed.2011.276
        • Datta S.K.
        • Oddone E.Z.
        • Olsen M.K.
        • et al.
        Economic analysis of a tailored behavioral intervention to improve blood pressure control for primary care patients.
        Am Heart J. 2010; 160: 257-263https://doi.org/10.1016/j.ahj.2010.05.024
        • Edelman D.
        • Fredrickson S.K.
        • Melnyk S.D.
        • et al.
        Medical clinics versus usual care for patients with both diabetes and hypertension.
        Ann Intern Med. 2010; 152: 689https://doi.org/10.7326/0003-4819-152-11-201006010-00001
        • Isetts B.J.
        • Schondelmeyer S.W.
        • Artz M.B.
        • et al.
        Clinical and economic outcomes of medication therapy management services: the Minnesota experience.
        J Am Pharm Assoc. 2008; 48: 203https://doi.org/10.1331/JAPhA.2008.07108
        • Katon W.J.
        • Lin E.H.B.
        • Von Korff M.
        • et al.
        Collaborative care for patients with depression and chronic illnesses.
        N Engl J Med. 2010; 363: 2611-2620https://doi.org/10.1056/NEJMoa1003955
        • Litaker D.
        • Mion L.C.
        • Planavsky L.
        • Kippes C.
        • Mehta N.
        • Frolkis J.
        Physician-nurse practitioner teams in chronic disease management: the impact on costs, clinical effectiveness, and patients’ perception of care.
        J Interprof Care. 2003; 17: 223-237https://doi.org/10.1080/1356182031000122852
        • Logan A.G.
        • Milne B.J.
        • Achber C.
        • Campbell W.P.
        • Haynes R.B.
        Cost-effectiveness of a worksite hypertension treatment program.
        Hypertens. 1981; 3: 211-218https://doi.org/10.1161/01.HYP.3.2.211
        • Logan A.G.
        • Milne B.J.
        • Flanagan P.T.
        • Haynes R.B.
        Clinical effectiveness and cost-effectiveness of monitoring blood pressure of hypertensive employees at work.
        Hypertens. 1983; 5: 828https://doi.org/10.1161/01.HYP.5.6.828
        • Lowey A.
        • Moore S.
        • Norris C.
        • Wright D.
        • Silcock J.
        • Hammond P.
        The cost-effectiveness of pharmacist-led treatment of cardiac risk in patients with type 2 diabetes.
        Pharm World Sci. 2007; 29: 541-545https://doi.org/10.1007/s11096-007-9101-7
        • Ma J.
        • Berra K.
        • Haskell W.L.
        • et al.
        Case management to reduce risk of cardiovascular disease in a county health care system.
        Arch Intern Med. 2009; 169: 1988https://doi.org/10.1001/archinternmed.2009.381
        • McGhee S.M.
        • McInnes G.T.
        • Hedley A.J.
        • Murray T.S.
        • Reid J.L.
        Coordinating and standardizing long-term care: evaluation of the west of Scotland shared-care scheme for hypertension.
        Br J Gen Pract. 1994; 44: 441
        • Munroe W.P.
        • Kunz K.
        • Dalmady-Israel C.
        • Potter L.
        • Schonfeld W.H.
        Economic evaluation of pharmacist involvement in disease management in a community pharmacy setting.
        Clin Ther. 1997; 19: 113-123https://doi.org/10.1016/S0149-2918(97)80078-1
        • Okamoto M.P.
        • Nakahiro R.K.
        Pharmacoeconomic evaluation of a pharmacist-managed hypertension clinic.
        Pharmacotherapy. 2001; 21: 1337-1344https://doi.org/10.1592/phco.21.17.1337.34424
        • Reed S.D.
        • Yanhong L.I.
        • Oddone E.Z.
        • et al.
        Economic evaluation of home blood pressure monitoring with or without telephonic behavioral self-management in patients with hypertension.
        Am J Hypertens. 2010; 23: 142-148https://doi.org/10.1038/ajh.2009.215
        • Wertz D.
        • Hou L.
        • DeVries A.
        • et al.
        Clinical and economic outcomes of the Cincinnati Pharmacy Coaching Program for diabetes and hypertension.
        Manag Care. 2012; 21: 44
        • Bogden P.E.
        • Abbott R.D.
        • Williamson P.
        • Onopa J.K.
        • Koontz L.M.
        Comparing standard care with a physician and pharmacist team approach for uncontrolled hypertension.
        J Gen Intern Med. 1998; 13: 740-745https://doi.org/10.1046/j.1525-1497.1998.00225.x
        • Borenstein J.E.
        • Graber G.
        • Saltiel E.
        • et al.
        Physician-pharmacist comanagement of hypertension: a randomized, comparative trial.
        Pharmacotherapy. 2003; 23: 209-216https://doi.org/10.1592/phco.23.2.209.32096
        • Bunting B.A.
        • Smith B.H.
        • Sutherland S.E.
        The Asheville Project: clinical and economic outcomes of a community-based long-term medication therapy management program for hypertension and dyslipidemia.
        J Am Pharm Assoc. 2008; 48: 23-31https://doi.org/10.1331/JAPhA.2008.07140
        • Carter B.L.
        • Barnette D.J.
        • Chrischilles E.
        • Mazzotti G.J.
        • Asali Z.J.
        Evaluation of hypertensive patients after care provided by community pharmacists in a rural setting.
        Pharmacotherapy. 1997; 17: 1274
        • Devine E.B.
        • Hoang S.
        • Fisk A.W.
        • Wilson-Norton J.L.
        • Lawless N.M.
        • Louie C.
        Strategies to optimize medication use in the physician group practice: the role of the clinical pharmacist.
        J Am Pharm Assoc. 2009; 49: 181-191https://doi.org/10.1331/JAPhA.2009.08009
        • Eckerlund I.
        • Jonsson E.
        • Ryden L.
        • Rastam L.
        • Berglund G.
        • Isacsson S.O.
        Economic evaluation of a Swedish medical care program for hypertension.
        Health Policy. 1985; 5: 299-306https://doi.org/10.1016/0168-8510(85)90047-8
        • Fedder D.O.
        • Chang R.J.
        • Curry S.
        • Nichols G.
        The effectiveness of a community health worker outreach program on healthcare utilization of West Baltimore City Medicaid patients with diabetes with or without hypertension.
        Ethn Dis. 2003; 13: 22-27
        • Forstrom M.J.
        • Ried L.D.
        • Stergachis A.S.
        • Corliss D.A.
        Effect of a clinical pharmacist program on the cost of hypertension treatment in an HMO family practice clinic.
        Ann Pharmacother. 1990; 24: 304-309
        • Kulchaitanaroaj P.
        • Brooks J.M.
        • Ardery G.
        • Newman D.
        • Carter B.L.
        Incremental costs associated with physician and pharmacist collaboration to improve blood pressure control.
        Pharmacotherapy. 2012; 32: 772-780https://doi.org/10.1002/j.1875-9114.2012.01103.x
        • Murray M.D.
        • Harris L.E.
        • Overhage J.M.
        • et al.
        Failure of computerized treatment suggestions to improve health outcomes of outpatients with uncomplicated hypertension: results of a randomized controlled trial.
        Pharmacotherapy. 2004; 24: 324-337https://doi.org/10.1592/phco.24.4.324.33173
        • Pezzin L.E.
        • Feldman P.H.
        • Mongoven J.M.
        • McDonald M.V.
        • Gerber L.M.
        • Peng T.R.
        Improving blood pressure control: results of home-based post-acute care interventions.
        J Gen Intern Med. 2011; 26: 280-286https://doi.org/10.1007/s11606-010-1525-4
        • Banach M.
        • Aronow W.S.
        Blood pressure J-curve: current concepts.
        Curr Hypertens Rep. 2012; 14: 556-566https://doi.org/10.1007/s11906-012-0314-3
        • Jaffe M.G.
        • Lee G.A.
        • Young J.D.
        • Sidney S.
        • Go A.S.
        Improved blood pressure control associated with a large-scale hypertension program.
        JAMA. 2013; 310: 699-705https://doi.org/10.1001/jama.2013.108769
        • Taplin S.H.
        • Foster M.K.
        • Shortell S.M.
        Organizational leadership for building effective health care teams.
        Ann Fam Med. 2013; 11: 279-281https://doi.org/10.1370/afm.1506
        • Davis K.
        • Abrams M.
        • Stremikis K.
        How the Affordable Care Act will strengthen the nation’s primary care foundation.
        J Gen Intern Med. 2011; 26: 1201-1203https://doi.org/10.1007/s11606-011-1720-y
        • Herring B.
        Suboptimal provision of preventive healthcare due to expected enrollee turnover among private insurers.
        Health Econ. 2010; 19: 438-448https://doi.org/10.1002/hec.1484