Cost-utility analysis of physician-pharmacist collaborative intervention for treating hypertension compared with usual care.
To estimate long-term costs and outcomes attributable to a physician-pharmacist collaborative intervention compared with physician management alone for treating essential hypertension.



A Markov model cohort simulation with a 6-month cycle length to predict acute coronary syndrome, stroke, and heart failure throughout lifetime was performed. A cohort of 399 patients was obtained from two prospective, cluster randomized controlled clinical trials implementing physician-pharmacist collaborative interventions in community-based medical offices in the Midwest, USA. Framingham risk equations and other algorithms were used to predict the vascular diseases. SBP reduction due to the interventions deteriorated until 5 years. Direct medical costs using a payer perspective were adjusted to 2015 dollar value, and the main outcome was quality-adjusted life years (QALYs); both were discounted at 3%. The intervention costs were estimated from the trials, whereas the remaining parameters were from published studies. A series of sensitivity analyses including changing patient risks of vascular diseases, probabilistic sensitivity analysis, and a cost-effectiveness acceptability curve were performed.



The lifetime incremental costs were $26 807.83 per QALY (QALYs gained = 0.14). The intervention provided the greatest benefit for the high-risk patients, moderate benefit for the trial patients, and the lowest benefit for the low-risk patients. If a payer is willing to pay $50 000 per QALY gained, in 48.6% of the time the intervention would be cost-effective.



Team-based care such as a physician-pharmacist collaboration appears to be a cost-effective strategy for treating hypertension. The intervention is most cost-effective for high-risk patients.
aDepartment of Pharmacy Practice and Science, College of Pharmacy, University of Iowa, Iowa City, Iowa, USA bHealth Economics Research Group (HERG), Department of Life Sciences, College of Health and Life Sciences, Brunel University London, Uxbridge, United Kingdom cDepartment of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA dSchool of Pharmacy, Monash University Malaysia, Subang Jaya, Selangor, Malaysia eCenter of Pharmaceutical Outcomes Research (CPOR), Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand fSchool of Pharmacy, University of Wisconsin, Madison, Wisconsin, USA gSchool of Population Health, University of Queensland, Brisbane, Queensland, Australia hDepartment of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa, USA.
Puttarin
P
Kulchaitanaroaj
John M
JM
Brooks
Nathorn
N
Chaiyakunapruk
Amber M
AM
Goedken
Elizabeth A
EA
Chrischilles
Barry L
BL
Carter
D000328:Adult; D000368:Aged; D003362:Cost-Benefit Analysis; D005260:Female; D017048:Health Care Costs; D006333:Heart Failure; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000191:economics*; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team; D010595:Pharmacists; D010820:Physicians; D011446:Prospective Studies; D019057:Quality-Adjusted Life Years; D020521:Stroke