Economics of Team-based Care in Controlling Blood Pressure : A Community Guide Systematic Review

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Submitted by National Center... on Dec 11, 2015 - 3:41pm CST

Resource Type: 
Journal Article

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.

Author(s): 
Verughese Jacob
Sajal K. Chattopadhyay
Anilkrishna
Krista K. Proia
Gibril Njie
David P. Hopkins
Ramona K.C. Finnie
Nicolaas P. Pronk
Thomas E. Kottke
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