Cost-Effectiveness of Hypertension Treatment by Pharmacists in Black Barbershops

Abstract

Background: In the Los Angeles Barbershop Blood Pressure Study (LABBPS), pharmacist-led hypertension care in Los Angeles County Black-owned barbershops significantly improved blood pressure control in non-Hispanic Black men with uncontrolled hypertension at baseline. In this analysis, 10-year health outcomes and healthcare costs of one year of the LABBPS intervention versus control are projected. Methods: A discrete event simulation of hypertension care processes projected blood pressure, medication-related adverse events, fatal and non-fatal cardiovascular disease events, and non-cardiovascular disease death in LABBPS participants. Program costs, total direct healthcare costs (2019 USD), and quality-adjusted life years (QALYs) were estimated for the LABBPS intervention and control arms from a healthcare sector perspective over a 10-year horizon. Future costs and QALYs were discounted 3% annually. High and intermediate cost-effectiveness thresholds were defined as <$50,000 and <$150,000 per QALY gained, respectively. Results: At 10 years, the intervention was projected to cost an average of $2,356 (95% uncertainty interval [UI] -$264-$4,611) more per participant than the control arm and gain 0.06 (95% UI 0.01-0.10) QALYs. The LABBPS intervention was highly cost-effective, with a mean cost of $42,717 per QALY gained (58% probability of being highly and 96% of being at least intermediately cost-effective). Exclusive use of generic drugs improved the cost-effectiveness to $17,162 per QALY gained. The LABBPS intervention would be only intermediately cost effective if pharmacists were less likely to intensify antihypertensive medications when systolic blood pressure was ≥150 mmHg or if pharmacist weekly time driving to barbershops increased. Conclusions: Hypertension care delivered by clinical pharmacists in Black barbershops is a highly cost-effective way to improve blood pressure control in Black men.

Cost-Effectiveness of Masked Hypertension Screening and Treatment in US Adults With Suspected Masked Hypertension: A Simulation Study

“…We used a microsimulation version of the CVD Policy Model, an established computer simulation of coronary heart disease (CHD) and stroke incidence and prevalence in US adults. 14–17 In the simulation, individuals started with no history of CVD and each year were at risk of experiencing CHD, stroke, both CHD and stroke, and dying from CVD or non-CVD-related causes ( Supplementary Figure S1 online). Individuals were simulated until age 89 years or death.…”

“…The model was populated with individuals from National Health and Nutrition Examination Survey (NHANES) 1999–2014 cycles who were matched to participants from the National Heart, Lung and Blood Institute Pooled Cohorts Study (NHLBI-PCS) for whom lifetime CVD risk factor trajectories (i.e., systolic BP [SBP], diastolic BP [DBP], high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, total cholesterol, current smoker, former smoker, cigarettes per day, creatinine, estimated glomerular filtration rate, and diabetes mellitus) have been developed. 14 , 15 , 18–21 Of these, individuals aged 20 years or older with suspected masked hypertension (i.e., mean of 3 SBP/DBP measurements 120–129 mm Hg/<80 mm Hg) with no history of CVD and no self-reported use of antihypertensive medications were included ( n = 1,223). 1 To achieve stable cost-effectiveness estimates, nationally representative cohorts of 100,000 US adults were simulated.…”

The cost-effectiveness of pharmacist-physician collaborative care models vs usual care on time in target systolic blood pressure range in patients with hypertension: a payer perspective

“…13 PPCCMs have been shown to not only be successful within an office-based setting, 13 but even within barbershops and churches. 14,15 A study by Matzke et al found significant improvements (P < 0.01) in hemoglobin, BP, and cholesterol in patients with multiple chronic conditions who were in the PPCCM group compared to those seen by usual care. Additionally, hospitalizations declined within the PPCCM group, which led to an estimated cost savings of $2,619 per patient.…”

“…Bryant et al modeled 10-year health outcomes and 1-year health care costs associated with pharmacist-led hypertension care in Black-owned barbershops in the Los Angeles Barbershop Blood Pressure Study (LABBPS) from a health care sector perspective. 14 They reported a mean cost of $42,717 per QALY gained. Kulchaitanaroaj et al similarly reported a PPCCM to be highly cost-effective from the payer perspective ($26,807 per QALY gained).…”

Addressing the Last-Mile Problem in Blood Pressure Control—Scaling Up Community-Based Interventions

“…At 6 months, participants receiving the pharmacist-led intervention were taking a greater number of blood pressure medications, including longer-acting medications, and achieved large reductions in systolic blood pressure (21.6 mm Hg compared with control) that were sustained through 1 year. We found this intervention to be cost-effective 4 and estimate that such a program has the potential to reach 1 in 3 Black men with hypertension and avert 40% of major adverse cardiovascular events in program participants. 5 However, reproducing the trial's impressive blood pressure reduction in real-world settings will require creative solutions for key implementation challenges.…”