Cost-Effectiveness of Hypertension Treatment by Pharmacists in Black Barbershops（Abstract）

Kelsey B. Bryant, MD, MPH, MS Andrew E. Moran, MD, MPH Dhruv S. Kazi, MD, MSc Yiyi Zhang, PhD Joanne Penko, MS, MPH Natalia Ruiz-Negrón, PharmD Pamela Coxson, PhD Ciantel A. Blyler, PharmD Kathleen Lynch, PharmD Laura P. Cohen, MD, MPP Gabriel S. Tajeu, DrPH, MPH Valy Fontil, MD, MAS Norma B. Moy, BA Joseph E. Ebinger, MD, MS Florian Rader, MD Kirsten Bibbins-Domingo, PhD, MD Brandon K. BellowsPharmD, MS

Originally published15 Apr 2021https://doi.org/10.1161/CIRCULATIONAHA.120.051683Circulation. 2021;143:2384–2394

Background:

In LABBPS (Los Angeles Barbershop Blood Pressure Study), pharmacist-led hypertension care in Los Angeles County Black-owned barbershops significantly improved blood pressure control in non-Hispanic Black men with uncontrolled hypertension at baseline. In this analysis, 10-year health outcomes and health care costs of 1 year of the LABBPS intervention versus control are projected.

Methods:

A discrete event simulation of hypertension care processes projected blood pressure, medication-related adverse events, fatal and nonfatal cardiovascular disease events, and noncardiovascular disease death in LABBPS participants. Program costs, total direct health care costs (2019 US dollars), and quality-adjusted life-years (QALYs) were estimated for the LABBPS intervention and control arms from a health care sector perspective over a 10-year horizon. Future costs and QALYs were discounted 3% annually. High and intermediate cost-effectiveness thresholds were defined as <$50 000 and <$150 000 per QALY gained, respectively.

Results:

At 10 years, the intervention was projected to cost an average of $2356 (95% uncertainty interval, –$264 to $4611) more per participant than the control arm and gain 0.06 (95% uncertainty interval, 0.01–0.10) QALYs. The LABBPS intervention was highly cost-effective, with a mean cost of $42 717 per QALY gained (58% probability of being highly and 96% of being at least intermediately cost-effective). Exclusive use of generic drugs improved the cost-effectiveness to $17 162 per QALY gained. The LABBPS intervention would be only intermediately cost-effective if pharmacists were less likely to intensify antihypertensive medications when systolic blood pressure was ≥150 mm Hg or if pharmacist weekly time driving to barbershops increased.

Conclusions:

Hypertension care delivered by clinical pharmacists in Black barbershops is a highly cost-effective way to improve blood pressure control in Black men.