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

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• 作者：Verughese Jacob ; PhD ; MPH¹ ; ^{hir0@cdc.gov" class="auth_mail" title="E-mail the corresponding author} ; Sajal K. Chattopadhyay ; PhD¹ ; Anilkrishna B. Thota ; MBBS ; MPH¹ ; Krista K. Proia ; MPH¹ ; Gibril Njie ; MPH¹ ; David P. Hopkins ; MD ; MPH¹ ; Ramona K.C. Finnie ; DrPH¹ ; Nicolaas P. Pronk ; PhD ; MA² ; Thomas E. Kottke ; MD² ; ; the Community Preventive Services Task Force¹
• 刊名：American Journal of Preventive Medicine
• 出版年：2015
• 出版时间：November 2015
• 年：2015
• 卷：49
• 期：5
• 页码：772-783
• 全文大小：448 K

文摘

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.

absSec_2">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.

absSec_3">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.

absSec_4">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.