Purpose: To help inform public health policymakers, we examined the cost-effectiveness (CE) of implementing a barbershop-based screening program to improve hypertension control in Black men, while exploring the impact of varying (1) the program’s effectiveness and (2) the cost of linking a participant to follow-up primary care.
Methods: A Markov model was developed to evaluate the CE of a blood pressure screening program at Black-owned barbershops as program characteristics change. The model was motivated by our ongoing clinical trial of hypertension and colorectal-cancer-screening for Black men. We projected the risk of coronary heart disease (CHD), end stage renal disease (ESRD), congestive heart failure (CHF), myocardial infarction, stroke, and all-cause mortality as a function of systolic blood pressure (SBP) and other risk factors. The New York City-Health and Nutrition Examination Survey informed the distribution of patient characteristics and baseline comorbidities. Healthcare costs and health-related quality of life were estimated using Medicare’s hierarchical-condition-categories model and EQ-5D health utilities. The program’s effectiveness and cost of linking a participant to follow-up were informed through our clinical trial and other sources. A societal perspective was adopted with a lifetime horizon and 3% discount rate.
Results: The CE of barbershop-based hypertension-screening varied from $6284 per quality-adjusted life-year (QALY) to $8482 per-QALY when the impact of the intervention on SBP fell from a reduction of 20 mmHg to 5 mmHg. Similarly, the CE varied from $5828 per-QALY to $7803 per-QALY when the cost of linking a participant to appropriate care increased from $100 to $1,000. The numbers needed to screen (NNTS) to prevent one case of incident CAD, ESRD, or CHF were 313, 2,500, and 834 respectively. The NNTS to prevent any of these conditions ranged from a low of 148 when SBP fell by 20 mmHg to a high of 715 when SBP fell by 5 mmHg. If this program were adopted in all NYC black-owned barbershops (serving approximately 68,054 hypertensive Black men), 217, 82, and 28 cases of CAD, ESRD, and CHF could be prevented at a cost of $161,536,654.
Conclusions: The CE of barbershop-based hypertension screening for Black men is sensitive to changes in the cost of linking participants to care, and the overall effectiveness of hypertension control. However, CE ratios remain favorable over a range of program assumptions.
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