Defense Date

2022

Document Type

Thesis

Degree Name

Master of Science

Department

Pharmacy - Dean's Office

First Advisor

Julie A. Patterson

Second Advisor

David A. Holdford

Third Advisor

Dave L. Dixon

Abstract

Background: Hypertension is highly prevalent in the United States, affecting nearly half of all adults (43%). Studies have shown that pharmacy-physician collaborative care models (PPCCM) for hypertension management significantly improve blood pressure (BP) control rates and provide consistent control of BP. Time in target range (TTR) for systolic BP is a novel measure of BP control consistency that is independently associated with decreased cardiovascular (CV) risk. There is no evidence observed improvement in TTR for systolic BP with PPCCM is cost effective.

Objective: This study aimed to compare the cost-effectiveness of PPCCM with usual care for the management of hypertension from the payer perspective with a decision analysis model and a Markov model.

Methods: Both the decision analysis model and the Markov model utilized a three-year time horizon based on published literature and publicly available data. The population consisted of adult patients who had a previous diagnosis of high BP (defined as office-based BP ³ 140/90 mmHg) or were receiving antihypertensive medication(s). Effectiveness data were drawn from two published studies evaluating the effect of PPCCM (vs. usual care) on TTR for systolic BP and the impact of TTR for systolic BP on four CV outcomes (nonfatal myocardial infarction (MI), stroke, heart failure (HF), and cardiovascular disease (CVD) death). Both models incorporated direct medical costs, including both programmatic costs (i.e., direct costs for provider time) and downstream healthcare utilization associated with the acute CV events; the Markov model also included the incremental post-CV event costs and recurrences of the same acute CV event. One-way sensitivity and threshold analyses examined model robustness.

Results: In base case analyses for the decision analysis model and Markov model, PPCCM hypertension management was associated with lower downstream medical expenditures (difference: -$162.86 and -$173.05, respectively) and lower total program costs (difference: $-108.00) per person treated when compared to usual care. PPCCM was associated with lower downstream medical expenditures across all parameter ranges tested in the deterministic sensitivity analysis. For every 10,000 hypertension patients managed with PPCCM vs. usual care over a three-year time horizon, the decision analysis and Markov models suggested that approximately 27 and 16 CVD deaths, 29 and 51 strokes, 21 and 42 non-fatal MIs, and 12 and 48 incident HF diagnoses, respectively, are expected to be averted.

Conclusion: This is the first study to model the cost-effectiveness of PPCCM compared to usual care on TTR for systolic BP in adults with hypertension. For both the decision analysis and Markov models, PPCCM was less costly to administer and resulted in downstream healthcare savings and fewer acute CV events relative to usual care. Although further research is needed to evaluate the long-term costs and outcomes of PPCCM, payer coverage of PPCCM services may prevent future healthcare costs and improve patient CV outcomes.

Rights

© The Author

Is Part Of

VCU University Archives

Is Part Of

VCU Theses and Dissertations

Date of Submission

5-3-2022

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