Cost-effectiveness of a peer and practice staff support intervention

Area of Science:

• Public Health
• Health Economics
• Cardiovascular Disease Prevention

Background:

• African Americans experience a disproportionately high burden of hypertension and coronary heart disease (CHD).
• Effective interventions are needed to manage blood pressure and reduce CHD risk in this population.
• Understanding the cost-effectiveness of such interventions is crucial for healthcare resource allocation.

Purpose of the Study:

• To evaluate the cost-effectiveness of a behavioral intervention aimed at reducing CHD risk and blood pressure in African Americans with uncontrolled hypertension.
• To compare a comprehensive behavioral support program with informational brochures.

Main Methods:

• A randomized clinical trial was conducted in urban primary care settings.
• Participants received either behavioral support (office practice and peer coach) or informational brochures.
• Stochastic cost-effectiveness analysis and a Markov model were used to assess short-term and lifetime cost-effectiveness.

Main Results:

• The behavioral intervention cost significantly more than the control group ($435.36 vs. $74.39).
• The incremental cost-effectiveness ratio (ICER) was $47 per mm Hg reduction in systolic blood pressure (SBP) and $453,419 per CHD event avoided in 6 months.
• Over a 10-year horizon, the ICER was $3998 per quality-adjusted life-year.

Conclusions:

• The behavioral intervention for hypertension in African Americans was not cost-effective in the initial 6 months.
• Sustained intervention effects over the long term suggest potential cost-effectiveness across a patient's lifetime.
• Further research on long-term adherence and impact is warranted.