Organized blood pressure control programs to prevent stroke in Australia : would they be cost-effective?

Cadilhac, Dominique A., Carter, Rob, Thrift, Amanda G. and Dewey, Helen M. 2012, Organized blood pressure control programs to prevent stroke in Australia : would they be cost-effective?, Stroke, vol. 43, no. 5, pp. 1370-1375.

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Title Organized blood pressure control programs to prevent stroke in Australia : would they be cost-effective?
Author(s) Cadilhac, Dominique A.
Carter, Rob
Thrift, Amanda G.
Dewey, Helen M.
Journal name Stroke
Volume number 43
Issue number 5
Start page 1370
End page 1375
Total pages 6
Publisher Lippincott Williams & Wilkins
Place of publication Philadelphia, Pa.
Publication date 2012-05
ISSN 0039-2499
1524-4628
Keyword(s) economic model
stroke
secondary prevention
primary prevention
Summary Background and Purpose—: High blood pressure (BP) is the most important modifiable stroke risk factor. Worldwide high BP in many people is uncontrolled or people are unaware of their BP status. We aimed to assess whether a program of organized multidisciplinary care and medication would be cost-effective for improving BP control for the prevention of stroke.

Methods—:
A novel aspect was to simulate the intervention to match recent primary care initiatives (eg, new Medicare reimbursement items) to ensure policy relevance. Current practice and additional costs of each intervention were included using the best available evidence. The differences in the cost per quality-adjusted life year (QALY) gained for the interventions were compared against current practice. Cost-effectiveness was defined as cost per QALY gained was less than Australian dollars (AUD) 50 000 (societal perspective; reference year 2004). The robustness of estimates was assessed with probabilistic multivariable uncertainty analysis.

Results—: For primary prevention, the median cost per QALY gained was AUD11 068 (95% uncertainty interval AUD5201 to AUD18 696) in those aged 75 years or older and was AUD17 359 (95% uncertainty interval AUD10 516 to AUD26 036) in those aged 55 to 84 years with >=15% absolute risk of stroke. Primary prevention interventions were not cost-effective if aged younger than 50 years. The median cost per QALY gained for secondary prevention was AUD1811 and AUD4704, depending on which medications were modeled.

Conclusions—: Organized care for BP control targeted at specific populations offers excellent value over current practice. Organized care for secondary prevention provided the greatest benefits and strongest cost-effectiveness. Translation into clinical practice requires improved use of relevant Medicare policy in Australia.
Language eng
Field of Research 140208 Health Economics
Socio Economic Objective 920103 Cardiovascular System and Diseases
HERDC Research category C1 Refereed article in a scholarly journal
Copyright notice ©2012, Lippincott Williams & Wilkins
Persistent URL http://hdl.handle.net/10536/DRO/DU:30047342

Document type: Journal Article
Collection: Population Health
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