Cost-effectiveness of a peer and practice staff support intervention

Objectives: We examined the cost-effectiveness of an intervention to reduce coronary heart disease (CHD) risk and blood pressure in African Americans. Study Design: Stochastic cost-effectiveness analysis alongside a clinical trial, augmented by a Markov model of lifetime cost-effectiveness. Methods: 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. Results: 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. Conclusions: 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.