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Effectiveness and Cost-Effectiveness of Team-Based Care for Hypertension: A Meta-Analysis and Simulation Study
Kelsey B Bryant1, Aditi S Rao2, Laura P Cohen2
1Icahn School of Medicine, Mount Sinai, New York, NY (K.B.B., N.B.).
Hypertension (Dallas, Tex. : 1979)
|March 8, 2023
Summary
Team-based care involving nonphysician medication titration significantly lowers blood pressure. This approach is a cost-effective strategy for managing hypertension and reducing related diseases in the US.
Area of Science:
- Cardiovascular Medicine
- Health Services Research
- Public Health
Background:
- Team-based care (TBC) is recommended for managing hypertension but optimal strategies remain unclear.
- Uncontrolled hypertension affects a significant portion of the US adult population.
- Identifying cost-effective TBC models is crucial for improving population health outcomes.
Approach:
- A meta-analysis synthesized data from 19 clinical trials involving 5993 US adults with uncontrolled hypertension.
- Systolic blood pressure (BP) reduction at 12 months was compared between TBC strategies and usual care.
- The BP Control Model-Cardiovascular Disease Policy Model projected long-term outcomes, including costs and quality-adjusted life years.
Key Points:
- TBC with nonphysician medication titration achieved a greater systolic BP reduction (-10.5 mm Hg) compared to TBC with physician titration (-5.0 mm Hg) versus usual care at 12 months.
- Over 10 years, TBC with nonphysician titration was projected to be cost-effective, gaining quality-adjusted life years at an estimated $4400/QALY.
- TBC with physician titration was less effective and more costly than TBC with nonphysician titration.
Conclusions:
- Team-based care incorporating nonphysician medication titration offers superior blood pressure control.
- This TBC strategy represents a cost-effective method for reducing hypertension-related morbidity and mortality.
- Implementing nonphysician-led TBC can improve cardiovascular health outcomes in the US population.
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