AN OVERVIEW OF COST-EFFECTIVENESS OF COMMUNITY-BASED INTERVENTIONS FOR CONTROLLING HIGH BLOOD PRESSURE

Purpose:

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.

Method:

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.

Result:

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. 

Conclusion:

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.