Economics of Team-based Care in Controlling Blood Pressure: A Community Guide Systematic Review
Section snippets
Context
High blood pressure (BP) presents a substantial economic burden in the U.S., fueled by increased medical expenditures, reduced worksite productivity from associated absences, and premature death. Recent U.S. studies estimate annual costs at $47.5 billion in direct medical expenses and $3.5 billion in lost productivity.1 High BP is an important risk factor for cardiovascular disease (CVD) and stroke: the 2014 statistical update from the American Heart Association estimated that CVD and stroke
Evidence Acquisition
General methods for Community Guide systematic economic reviews are available at www.thecommunityguide.org/about/economics.html. Methods specific to the present review are detailed below.
A systematic review team (the team) was constituted, including subject matter experts on CVD from various agencies, organizations, and academic institutions together with qualifıed systematic reviewers from The Community Guide branch at CDC. The team worked under the oversight of the Community Preventive
Evidence Synthesis
Table 1 provides an overview of four characteristics of included studies: location, setting, presence of control group, and period of publication. Details of the included studies are available at www.thecommunityguide.org/cvd/supportingmaterials/SETecon-Team-Based-Care.pdf. Table 2 summarizes the type of economic analyses conducted in included studies.
Discussion
The major caveat in this review is that the formulae for the relationship between SBP and QALY were drawn from the experience of people with diabetes and comorbid high BP. It is not clear whether, and to what extent, limiting the study populations to people with diabetes leads to an overestimation or underestimation of the relationship between SBP and QALYs. Even though it is possible that the overall QALYs may be worse for diabetic patients than hypertensive patients, the relative impact of
Acknowledgments
This review would not have been possible without the subject matter expertise and contributions of our coordination team in the Community Guide Branch at CDC, from other areas of CDC, and our external partners: David B. Callahan, MD, Office of Public Health Preparedness and Response, CDC; Diane Dunet, MPA, PhD, Division of Heart Disease and Stroke Prevention, CDC; external partners, Kimberly J. Rask, MD, PhD, Emory University, Atlanta; Daniel T. Lackland, DrPH, Medical University of South
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From 1The Community Guide Branch, Division of Public Health Information Dissemination, Center for Surveillance, Epidemiology, and Laboratory Services, CDC, Atlanta, Georgia; and 2HealthPartners, Minneapolis, Minnesota
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The names and affiliations of the Task Force members are at www.thecommunityguide.org/about/task-force-members.html