title: Cost-effectiveness of a peer and practice staff support intervention.
abstract: We examined the cost-effectiveness of an intervention to reduce coronary heart disease (CHD) risk and blood pressure in African Americans.
  
  
  
  Stochastic cost-effectiveness analysis alongside a clinical trial, augmented by a Markov model of lifetime cost-effectiveness.
  
  
  
  In 2 urban academic primary care practices, we randomized African American patients with uncontrolled hypertension to a 6-month intervention of office practice and peer coach behavioral support (N = 136) or informational brochures about CHD risk factors (N = 144). Costs were estimated from the perspective of the provider. Outcomes included estimated CHD events avoided over 6 months and reduction in systolic blood pressure (SBP) (mm Hg). Subgroup analysis was performed for compliers who received an "effective" dose of the peer coach and office staff visits. Long-term cost-effectiveness was estimated by applying the clinical trial cost and effectiveness into a Markov model of CHD risk.
  
  
  
  The average cost for the behavioral support intervention group was $435.36 compared with $74.39 for the brochure control group. The incremental cost-effectiveness ratio (ICER) was $47 per mm Hg reduction in SBP and $453,419 per CHD event avoided in 6 months. Modeled over a 10-year horizon, the intervention had an ICER only as high as $3998 per incremental quality-adjusted life-year.
  
  
  
  A community-primary care practice behavioral intervention to reduce hypertension in African Americans with sustained uncontrolled hypertension does not appear to be cost-effective in the first 6 months. If intervention results are sustained over the long term, the program may be cost-effective over the patient's lifetime.
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Hollenbeak
authors.forename: Mark G
authors.initials: MG
authors.lastname: Weiner
authors.affiliation: REACH Center, University of Texas Health Science Center, 1 Technology Center, 7411 John Smith Drive, Ste 1100, San Antonio, TX 78229. E-mail: turner@uthscsa.edu.
authors.forename: Barbara J
authors.initials: BJ
authors.lastname: Turner
mesh_terms: D000328:Adult; D000368:Aged; D000488:Allied Health Personnel; D044383:Black People; D003327:Coronary Disease / Q000208:ethnology / Q000517:prevention & control*; D003362:Cost-Benefit Analysis; D003376:Counseling; D006801:Humans; D006973:Hypertension / Q000208:ethnology / Q000517:prevention & control; D008390:Markov Chains; D008875:Middle Aged; D010379:Peer Group; D011320:Primary Health Care; D012944:Social Support; D019037:Urban Health Services / Q000191:economics; D001741:Black or African American