Long-term cost-effectiveness of pharmacist-managed hypertension care in China

Hypertension is one of the main causes of cardiovascular and kidney diseases in China. However, the rate of effective blood pressure control remains low. Previous studies have shown pharmacist-managed hypertension care can improve treatment outcomes. Nevertheless, the long-term cost-effectiveness of pharmaceutical care has not been fully evaluated in China.

This study constructed a Markov model to evaluate the cost-effectiveness of pharmacist-managed hypertension care compared with usual care. The model followed a hypothetical patient cohort using 6-month cycles and extended to their life expectancy, adopting a healthcare system perspective. Model parameters were obtained from a randomized controlled trial and published Chinese population data. The primary outcomes included total costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs). Sensitivity and scenario analyses were conducted to test the robustness of the results. Cumulative medical costs and potential savings from implementing pharmacist-managed hypertension care were estimated.

Pharmacist-managed hypertension care increased QALYs by 0.07 per person and increased medical costs by $262.58. The ICER was $3,708 per QALY, which is lower than the accepted willingness-to-pay threshold in China. Pharmacist-managed hypertension care reduced the incidence of cardiovascular and renal events and reduced overall healthcare expenditures in these disease areas. Scenario analyses showed that earlier implementation, better medication adherence, and lower service fees further improved cost-effectiveness. The national cumulative costs and savings analysis indicated that the greatest savings occurred in the population aged 65 years and older over a 10-year period.

Pharmacist-managed care for hypertension is an economical and effective strategy in China. These findings support policies that promote the integration of pharmaceutical care into chronic disease management and healthcare payment systems.