title: Economic analysis of Heart and Stroke Foundation of Ontario's Hypertension Management Initiative.
abstract: OBJECTIVE
  Hypertension is suboptimally treated in primary care settings. We 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, we created two matched groups: pre-HMI (standard care), and post-HMI (n = 1720). For each patient, we 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 mmHg vs 134 mmHg 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 $4939 CAD per life-year gained.
  
  
  CONCLUSIONS
  We found that the HMI is a cost-effective means of providing evidence-informed, chronic disease management in primary care to patients with hypertension.
authors.affiliation: University Health Network, Toronto, ON, Canada ; Toronto Health Economics and Technology Assessment Collaborative, Toronto, ON, Canada.
authors.forename: Claire
authors.initials: C
authors.lastname: de Oliveira
authors.forename: Harindra C
authors.initials: HC
authors.lastname: Wijeysundera
authors.forename: Sheldon W
authors.initials: SW
authors.lastname: Tobe
authors.forename: Margaret Moy
authors.initials: MM
authors.lastname: Lum-Kwong
authors.forename: Shirley
authors.initials: S
authors.lastname: Von Sychowski
authors.forename: Xuesong
authors.initials: X
authors.lastname: Wang
authors.forename: Jack V
authors.initials: JV
authors.lastname: Tu
authors.forename: Murray D
authors.initials: MD
authors.lastname: Krahn