Economic analysis of Heart and Stroke Foundation of Ontario’s Hypertension Management Initiative

de Oliveira C, Wijeysundera HC, Tobe SW, Lum-Kwong MM, Von Sychowski S, Wang X, Tu JV, Krahn MD. Clinicoecon Outcomes Res. 2012; 4:323-36. Epub 2012 Nov 13.

Objectives — Hypertension is suboptimally treated in primary care settings. The researchers evaluated the cost-effectiveness of the Heart and Stroke Foundation of Ontario’s Hypertension Management Initiative (HMI), an interdisciplinary, evidence-informed chronic disease management model for primary care that focuses on improving blood pressure management and control by primary care providers and patients according to clinical best practice guidelines.

Methods — The perspective of our analysis was that of the Ontario Ministry of Health and Long-Term Care with a lifetime horizon and 5% annual discount rate. Using data from a prospective cohort study from the HMI, the researchers created two matched groups: pre-HMI (standard care), and post-HMI (n = 1720). For each patient, the researchers estimated the 10-year risk of cardiovascular disease (CVD) using the Framingham risk equation and life expectancy from life tables. Long-term health care costs incurred with physician visits, acute and chronic care hospitalizations, emergency department visits, same-day surgeries, and medication use were determined through linkage to administrative databases, using a bottom-up approach.

Results — The HMI intervention was associated with significant reductions in systolic blood pressure (126 mm Hg vs 134 mm Hg with standard care; P-value < 0.001). These improvements were associated with a reduction in the 10-year risk of CVD (9.5% risk vs 10.7% in standard care; P-value < 0.001) and a statistically significant improvement in discounted life expectancy (9.536 years vs 9.516 in standard care; P-value < 0.001). The HMI cohort had a discounted mean lifetime cost of $22,884 CAD vs $22,786 CAD for standard care, with an incremental cost-effectiveness ratio of $4,939 CAD per life-year gained.

Conclusion — The researchers found that the HMI is a cost-effective means of providing evidence-informed, chronic disease management in primary care to patients with hypertension.

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