Care Management to Reduce Disparities and Control Hypertension in Primary Care
| Autor: | Katherine B. Dietz, William V. Padula, Tanvir Hussain, Jill A. Marsteller, Jonathan C. Hong, Jennifer P. Halbert, Lisa A. Cooper, Ilene L. Hollin |
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| Rok vydání: | 2018 |
| Předmět: |
Adult
Male Research design medicine.medical_specialty Cost-Benefit Analysis MEDLINE 030204 cardiovascular system & hematology Risk Assessment 03 medical and health sciences 0302 clinical medicine Health care medicine Humans 030212 general & internal medicine health care economics and organizations Aged Aged 80 and over Patient Care Team Primary Health Care Cost–benefit analysis business.industry Age Factors Public Health Environmental and Occupational Health Health Status Disparities Cost-effectiveness analysis Middle Aged Health equity Black or African American Blood pressure Socioeconomic Factors Hypertension Emergency medicine Regression Analysis Female business Risk assessment |
| Zdroj: | Medical Care. 56:179-185 |
| ISSN: | 0025-7079 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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