Study Identifies Most Cost-Effective Team-based Care Strategy for Hypertension

A care team comprised of 2 or more health care professionals may be the most cost-effective approach to reduce hypertension-related morbidity and mortality in the United States according to recent research published in Hypertension.

 Researchers conducted a meta-analysis to gauge the effectiveness and cost of team-based care (TBC) as a strategy to manage patients blood pressure (BP).

For the meta-analysis, researchers assessed data from 19 clinical trials of 5993 US adults aged 20 years or younger with uncontrolled hypertension (≥140/90 mm Hg) and compared systolic BP reduction in patients utilizing TBC strategies vs patients experiencing non-TBC care. 

“TBC strategies were stratified by the inclusion of a nonphysician team member who could titrate antihypertensive medications,” said researchers. “The validated BP Control Model-Cardiovascular Disease Policy Model was used to project the expected BP reductions out to 10 years and simulate cardiovascular disease events, direct health care costs, quality-adjusted life years, and cost-effectiveness of TBC with physician and nonphysician titration.”

At 12 months, patients recieving routine care experienced a systolic BP change vs usual care of -5.0 (95% CI, -7.9 to -2.2) mm Hg for TBC with physician titration and -10.5 (-16.2 to -4.8) mm Hg for TBC with nonphysician titration. 

From a cost perspective, relative to usual care at 10 years TBC with was estimated to cost $95 more per patient and gain 0.022 (0.003-0.042) quality-adjusted life years, and $4400/quality-adjusted life year gained. 

“TBC with physician titration was estimated to cost more and gain fewer quality-adjusted life years than TBC with nonphysician titration,” researchers said.

The study results indicate that a TBC strategy with nonphysician titration yields superior hypertension outcomes compared with other strategies, and provides benefits such as improved blood pressure, fewer cardiovascular disease events, lower health care costs, and higher quality-adjusted life years.

Reference:
Bryant KB, Rao AS, Cohen LP, et al. Effectiveness and cost-effectiveness of team-based care for hypertension: A meta-analysis and simulation study. Hypertension. Published online March 8, 2023. doi:10.1161/HYPERTENSIONAHA.122.20292