title: Economics of Team-based Care in Controlling Blood Pressure: A Community Guide Systematic Review.
abstract: BACKGROUND
  High blood pressure is an important risk factor for cardiovascular disease and stroke, the leading cause of death in the U.S., and a substantial national burden through lost productivity and medical care. A recent Community Guide systematic review found strong evidence of effectiveness of team-based care in improving blood pressure control. The objective of the present review is to determine from the economic literature whether team-based care for blood pressure control is cost beneficial or cost effective.
  
  
  METHODS
  Electronic databases of papers published January 1980-May 2012 were searched to find economic evaluations of team-based care interventions to improve blood pressure outcomes, yielding 31 studies for inclusion.
  
  
  RESULTS
  In analyses conducted in 2012, intervention cost, healthcare cost averted, benefit-to-cost ratios, and cost effectiveness were abstracted from the studies. The quality of estimates for intervention and healthcare cost from each study were assessed using three elements: intervention focus on blood pressure control, incremental estimates in the intervention group relative to a control group, and inclusion of major cost-driving elements in estimates. Intervention cost per unit reduction in systolic blood pressure was converted to lifetime intervention cost per quality-adjusted life-year (QALY) saved using algorithms from published trials.
  
  
  CONCLUSIONS
  Team-based care to improve blood pressure control is cost effective based on evidence that 26 of 28 estimates of $/QALY gained from ten studies were below a conservative threshold of $50,000. This finding is salient to recent U.S. healthcare reforms and coordinated patient-centered care through formation of Accountable Care Organizations.
authors.affiliation: The Community Guide Branch, Division of Public Health Information Dissemination Center for Surveillance, Epidemiology, and Laboratory Services, CDC, Atlanta, Georgia. Electronic address: hir0@cdc.gov.
authors.forename: Verughese
authors.initials: V
authors.lastname: Jacob
authors.affiliation: The Community Guide Branch, Division of Public Health Information Dissemination Center for Surveillance, Epidemiology, and Laboratory Services, CDC, Atlanta, Georgia.
authors.forename: Sajal K
authors.initials: SK
authors.lastname: Chattopadhyay
authors.affiliation: The Community Guide Branch, Division of Public Health Information Dissemination Center for Surveillance, Epidemiology, and Laboratory Services, CDC, Atlanta, Georgia.
authors.forename: Anilkrishna B
authors.initials: AB
authors.lastname: Thota
authors.affiliation: The Community Guide Branch, Division of Public Health Information Dissemination Center for Surveillance, Epidemiology, and Laboratory Services, CDC, Atlanta, Georgia.
authors.forename: Krista K
authors.initials: KK
authors.lastname: Proia
authors.affiliation: The Community Guide Branch, Division of Public Health Information Dissemination Center for Surveillance, Epidemiology, and Laboratory Services, CDC, Atlanta, Georgia.
authors.forename: Gibril
authors.initials: G
authors.lastname: Njie
authors.affiliation: The Community Guide Branch, Division of Public Health Information Dissemination Center for Surveillance, Epidemiology, and Laboratory Services, CDC, Atlanta, Georgia.
authors.forename: David P
authors.initials: DP
authors.lastname: Hopkins
authors.affiliation: The Community Guide Branch, Division of Public Health Information Dissemination Center for Surveillance, Epidemiology, and Laboratory Services, CDC, Atlanta, Georgia.
authors.forename: Ramona K C
authors.initials: RKC
authors.lastname: Finnie
authors.affiliation: HealthPartners, Minneapolis, Minnesota.
authors.forename: Nicolaas P
authors.initials: NP
authors.lastname: Pronk
authors.affiliation: HealthPartners, Minneapolis, Minnesota.
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Kottke
mesh_terms: D003362:Cost-Benefit Analysis / Q000379:methods*; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D006973:Hypertension / Q000517:prevention & control*; D018802:Patient-Centered Care / Q000191:economics*; D019057:Quality-Adjusted Life Years; D014481:United States