Training providers in hypertension guidelines: Cost-effectiveness evaluation of a continuing medical education program in South Carolina

Abstract

Translation of published guidelines to clinical practice through continuing medical education (CME) can be effective at changing provider practice patterns and patient outcomes. Yet, cost-effectiveness analyses of CME interventions are rare. This study analyzed the cost-effectiveness of a CME program for improving patient hypertension outcomes relative to usual care. A CME, conducted by the Carolinas and Georgia chapter of the American Society of Hypertension, the Medical University of South Carolina, and the Heart Disease and Stroke Prevention Division of the South Carolina Department of Health and Environmental Control, trained primary care providers in evidence-based guidelines for hypertension prevention and control. A cost-effectiveness simulation model was created with inputs from primary data collection of program costs and secondary data analysis of the Hypertension Initiative Database for years 2000 through 2008. The data analysis consisted of a convenience sample of 8,183 patients in the Hypertension Initiative Database who saw a CME-trained provider at least once before and after the provider's training. Control patients saw providers who did not attend a CME program and were matched to CME patients using propensity score matching. Incremental life-years gained (LYG) for CME compared with no intervention were 0.003 per patient. The incremental cost-effectiveness ratio was $39,494 ($19,184-$73,864) per LYG under optimistic assumptions and $54,755 ($32,423-$95,728) per LYG under pessimistic assumptions. These results were most sensitive to changes in the effectiveness of the intervention on systolic blood pressure. The intervention is likely a cost-effective strategy to address hypertension in a real-world setting and can serve as a model for future innovations in hypertension prevention.