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Economics of Team-based Care in Controlling Blood Pressure: A Community Guide Systematic Review
Filetype[PDF - 908.10 KB]


Details:
  • Corporate Authors:
    Community Preventive Services Task Force
  • Pubmed ID:
    26477804
  • Pubmed Central ID:
    PMC4685935
  • Funding:
    CC999999/Intramural CDC HHS/United States
  • Document Type:
  • Collection(s):
  • Description:
    Context

    High blood pressure is an important risk factor for cardiovascular disease (CVD) 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 was to determine from the economic literature whether team-based care for blood pressure control is cost-beneficial and/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.

    Conclusion

    Team-based care to improve blood pressure control is cost-effective based on evidence that 26 of 28 estimates of $/QALY gained from 10 studies were below a conservative threshold of $50,000. This finding is salient to recent health care reforms in the U.S. and coordinated patient-centered care through formation of Accountable Care Organizations (ACOs).