Abstract P156: Long-Term Blood Pressure Outcomes and Costs Associated With a Barber-Pharmacist Hypertension Intervention: 10-Year Simulation of the Los Angeles Barber Trial

• Published in: Hypertension (Dallas, Tex. 1979) Vol. 74; no. Suppl_1
• Main Authors: Bryant, Kelsey B, Kazi, Dhruv S, Fontil, Valy, Penko, Joanne, Blyler, Ciantel A, Lynch, Kathleen, Ebinger, Joseph, Moy, Norma B, Rader, Florian, Bibbins-Domingo, Kirsten, Moran, Andrew E, Bellows, Brandon K
• Format: Journal Article
• Language: English
• Published: 01.09.2019
• ISSN: 0194-911X; 1524-4563
• DOI: 10.1161/hyp.74.suppl_1.P156

Abstract only Background: Barber-pharmacist blood pressure (BP) management reduced systolic BP >20 mm Hg compared to education alone over one year in Non-Hispanic (NH) black men with uncontrolled hypertension (HTN) in the Los Angeles BARBER (LA-BARBER) Trial. Long-term BP outcomes and costs of this intervention are unknown. Objective: Simulate 10-year BP outcomes and intervention and medication costs of a one-year barber-pharmacist HTN intervention followed by usual care compared to usual care alone. Methods: We simulated 1000 LA BARBER-eligible NH black men sampled from the National Health and Nutrition Examination Survey. We used a discrete event simulation version of the validated BP Control Model to predict BP outcomes over 10 years. Model inputs were derived from published literature, national sources, LA-BARBER individual participant data, and interviews with LA-BARBER intervention pharmacists. Medication and intervention (clinical care, travel, and administrative time) costs were calculated from a 2018 US payer perspective and discounted 3% annually. Primary outcomes were percent with BP <130/80 mm Hg, medication and intervention costs, and the cost per patient with BP controlled. We used 100 probabilistic model iterations to examine parameter uncertainty. Results: Our calibrated model accurately reproduced baseline characteristics and predicted 1-year BP outcomes of the LA-BARBER study (mean age 54 years, baseline BP 153/91 mm Hg, 69% predicted 1-year BP control with the barber-pharmacist HTN intervention). Over 10 years, 64% of patients (95% uncertainty interval [UI] 61%-67%) were predicted to achieve BP control with the barber-pharmacist HTN intervention compared to 38% (95% UI 26%-48%) with usual care. Projected intervention and medication costs were $8084 (95% UI $7664-$8598) with the barber-pharmacist intervention compared to $4183 ($3514-$4768) with usual care costing $15,000 per controlled patient gained. Conclusions: Medication and intervention costs for a barber-pharmacist HTN intervention were about double usual care, but it achieved substantially higher BP control rates. Ongoing research will examine if this strategy meets traditional cost-effectiveness thresholds (e.g.,<$100,000 per quality-adjusted life year).