AN OVERVIEW OF COST-EFFECTIVENESS OF COMMUNITY-BASED INTERVENTIONS FOR CONTROLLING HIGH BLOOD PRESSURE
Community-based interventions for controlling high blood pressure have played a vital role in reducing the morbidity and mortality of cardiovascular disease. This study summarizes the cost-effectiveness outcomes by reviewing the literature published in the past 2 decades.
We selected peer-reviewed literature during January 1995 through December 2015 by searching the databases of PubMed, CINAHL, MEDLINE, EMBASE, EcoLit, Cochrane Library and PsycINFO. We categorized the interventions into: (1) educational interventions; (2) blood pressure self-monitoring interventions; and (3) population-based screening. We summarized the incremental cost-effectiveness ratios (ICER) by types of interventions. ICERs were adjusted to 2014 US dollars using purchasing power parity exchange rate and the consumer price index medical care component.
We identified 34 articles (16 from the United States and 18 from other countries). Among those, there were 25 studies on educational interventions for lifestyle modification and medication adherence, 3 on self-monitoring interventions, and 6 on population-based screening interventions. In the US, the incremental costs of educational interventions range from $39.8 to $114 for 1 mmHg reduction in systolic blood pressure (SBP) per hypertensive patient and from $1271 to $58,610 for one life year gained (LYG). Outside the US, educational intervention costs from $0.62 (China) to $28.9 (Pakistan) for 1 mmHg reduction in SBP. Self-monitoring interventions, only evaluated in the US, cost $727 for 1 mmHg reduction in SBP and $41,927 for one LYG. Population-based screening interventions cost from $21,734 to $56,750 per QALY in the US, from $613 to $5,637 in Australia, and from $7,000 to $18,000 in China. In general, intervention costs to reduce 1 mmHg blood pressure, or one LYG, or one QALY was higher in the US than in other countries. However, there are limitations in the literature. For example, nearly a third (32%) of the articles did not have a comparison group, over half (53%) did not value costs properly, and about 44% did not perform sensitivity analyses.
Although evidence was mixed, most studies on educational interventions found that the interventions were either cost-effective or cost saving. The cost-effectiveness evidence on self-monitoring and screening interventions are inconclusive due to limited number of studies. These interventions require further evaluation. There is a need to improve the quality of the literature.