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

Verughese Jacob, Sajal K. Chattopadhyay, Anilkrishna B. Thota, Krista K. Proia, Gibril Njie, David P. Hopkins, Ramona K.C. Finnie, Nicolaas P. Pronk, Thomas E. Kottke, Community Preventive Services Task Force

Research output: Contribution to journalReview articlepeer-review

27 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)772-783
Number of pages12
JournalAmerican journal of preventive medicine
Volume49
Issue number5
DOIs
StatePublished - Nov 2015

Bibliographical note

Funding Information:
The work of Krista Proia, Gibril Njie, and Ramona Finnie was supported with funds from the Oak Ridge Institute for Scientific Education.

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