title: Organized blood pressure control programs to prevent stroke in Australia: would they be cost-effective?
abstract: OBJECTIVE
  High blood pressure (BP) is the most important modifiable stroke risk factor. Worldwide high BP in many people is uncontrolled or people are unaware of their BP status. We aimed to assess whether a program of organized multidisciplinary care and medication would be cost-effective for improving BP control for the prevention of stroke.
  
  
  METHODS
  A novel aspect was to simulate the intervention to match recent primary care initiatives (eg, new Medicare reimbursement items) to ensure policy relevance. Current practice and additional costs of each intervention were included using the best available evidence. The differences in the cost per quality-adjusted life year (QALY) gained for the interventions were compared against current practice. Cost-effectiveness was defined as cost per QALY gained was less than Australian dollars (AUD) 50 000 (societal perspective; reference year 2004). The robustness of estimates was assessed with probabilistic multivariable uncertainty analysis.
  
  
  RESULTS
  For primary prevention, the median cost per QALY gained was AUD11 068 (95% uncertainty interval AUD5201 to AUD18 696) in those aged 75 years or older and was AUD17 359 (95% uncertainty interval AUD10 516 to AUD26 036) in those aged 55 to 84 years with ≥15% absolute risk of stroke. Primary prevention interventions were not cost-effective if aged younger than 50 years. The median cost per QALY gained for secondary prevention was AUD1811 and AUD4704, depending on which medications were modeled.
  
  
  CONCLUSIONS
  Organized care for BP control targeted at specific populations offers excellent value over current practice. Organized care for secondary prevention provided the greatest benefits and strongest cost-effectiveness. Translation into clinical practice requires improved use of relevant Medicare policy in Australia.
authors.affiliation: Monash University, Victoria, Australia. dominique.cadilhac@monash.edu
authors.forename: Dominique A
authors.initials: DA
authors.lastname: Cadilhac
authors.forename: Rob
authors.initials: R
authors.lastname: Carter
authors.forename: Amanda G
authors.initials: AG
authors.lastname: Thrift
authors.forename: Helen M
authors.initials: HM
authors.lastname: Dewey
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000191:economics / Q000494:pharmacology / Q000627:therapeutic use*; D001315:Australia; D001794:Blood Pressure / Q000187:drug effects / Q000502:physiology*; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000503:physiopathology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D018803:Models, Economic; D009313:National Health Programs / Q000191:economics*; D019057:Quality-Adjusted Life Years; D012307:Risk Factors; D055502:Secondary Prevention / Q000191:economics*; D020521:Stroke / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control*
chemical_list: D000959:Antihypertensive Agents