Care Management to Reduce Disparities and Control Hypertension in Primary Care

Jonathan C. Hong, William V. Padula, Ilene L. Hollin, Tanvir Hussain, Katherine B. Dietz, Jennifer P. Halbert, Jill A. Marsteller, Lisa A. Cooper

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

Background: Project ReD CHiP (reducing disparities and controlling hypertension in primary care) care management was a clinic-based intervention that aimed to improve blood pressure control through improved care coordination and provide self-management support to patients from racially and socioeconomically. Objective: To evaluate the cost-effectiveness of ReD CHiP care management versus standard care to treat hypertension in diverse communities. Research Design: Microsimulation model from a health care sector perspective over 15 years. We used the published literature to inform our model including the ReD CHiP trial and the age-specific and race-specific cardiovascular disease risk equations. Deterministic and probabilistic sensitivity analyses were conducted to assess the uncertainty. Subjects: Primary prevention in a racially diverse setting. Measures: Costs per quality-Adjusted life years (QALYs) to produce an incremental cost-effectiveness ratio (ICER). Results: ReD CHiP had an increase of 2114 and 0.04 QALYs. The ICER was 52,850/QALY. Predominately African American (ICER: 48,250/QALY) and elderly populations (ie, age 65+) derived value from ReD CHiP (ICER: 39,525/QALY). The value of ReD CHiP varied with changes in the reduction in systolic blood pressure (5 mm Hg reduction, ICER: 133,300/QALY; 15 mm Hg reduction, ICER: 18,767/QALY). Probabilistic sensitivity analysis indicated that ReD CHiP CM was cost-effective in over 90% of simulations, based on a willingness-To-pay of 100,000/QALY. Conclusions: ReD CHiP care management is cost-effective to prevent negative consequences of hypertension. African American and elderly patients have more favorable ICERs, recommending targeted interventions to improve health equity among vulnerable patient populations.

Original languageEnglish (US)
Pages (from-to)179-185
Number of pages7
JournalMedical Care
Volume56
Issue number2
DOIs
StatePublished - 2018

Keywords

  • cost-effectiveness analysis
  • health disparities
  • hypertension
  • primary care management

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

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