Abstract 15672: Cost-Effectiveness of Team-Based Care for Hypertension

Abstract

Introduction: Team-based care (TBC), typically involving a physician and non-physician working in collaboration, is more effective than usual physician-only care in reducing blood pressure (BP). This analysis estimated the cost-effectiveness of TBC strategies vs. usual care over 10 years. Methods: We used the Cardiovascular Disease (CVD) Policy Model to project long-term BP, CVD events, and survival in a nationally representative cohort of 10,000 US adults (aged ≥20 years) with uncontrolled BP (≥140/90 mmHg) from the National Health and Nutrition Examination Survey. We compared (1) usual care, (2) TBC with a registered nurse providing hypertension counseling, and (3) TBC with a pharmacist providing counseling and titrating medications. BP reductions with TBC were derived from meta-analysis; other inputs were derived from published literature and publicly available data. TBC interventions were simulated to last six months, after which individuals were assumed to return to usual care. The outcomes were mean per-patient direct healthcare costs (2021 USD), quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs) from a US healthcare sector perspective. Sensitivity analyses assessed the impact of TBC program design and hypertension care process parameters on the cost-effectiveness of TBC. Results: The mean (SD) age was 59.8 (16.6) years, 50.0% were female, and mean baseline systolic BP was 150.9 (14.2) mmHg. At 10 years, TBC with nurse counseling and with pharmacist titration were projected to result in mean (95% uncertainty interval) 0.6-mmHg (0.4, 0.8) and 2.8-mmHg (2.2, 3.4) greater reductions in systolic BP. Both TBC strategies were estimated to dominate (i.e., cost less and more effective) usual care, with nurse counseling projected to cost -$617 (-$1539, $364) and with pharmacist titration -$416 (-$1400, $470) less than usual care. Compared with TBC with nurse counseling, TBC with pharmacist titration had an ICER of $13,000/QALY gained (88.0% probability ICER <$50,000/QALY gained). The ICER was most sensitive to the probability of pharmacist medication intensification. Conclusions: TBC with pharmacist titration is a cost-effective strategy to reduce CVD events in US adults with uncontrolled hypertension.