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Randomized Controlled Trial
. 2016 Jul-Aug;56(4):389-96.
doi: 10.1016/j.japh.2016.03.002. Epub 2016 May 13.

Cost-effectiveness of Wisconsin TEAM model for improving adherence and hypertension control in black patients

Theresa I Shireman, Bonnie L Svarstad
Randomized Controlled Trial

Cost-effectiveness of Wisconsin TEAM model for improving adherence and hypertension control in black patients

Theresa I Shireman et al. J Am Pharm Assoc (2003). 2016 Jul-Aug.

Abstract

Objectives: To assess the cost-effectiveness of the 6-month Team Education and Adherence Monitoring (TEAM) intervention for black patients with hypertension in community pharmacies using prospectively collected cost data.

Design: Cost-effectiveness analysis of a cluster-randomized trial.

Setting: Twenty-eight chain pharmacies in 5 Wisconsin cities from December 2006 to February 2009.

Participants: Five hundred seventy-six black patients with uncontrolled hypertension.

Intervention: Pharmacists and pharmacy technicians using novel tools for improving adherence and feedback to patients and physicians as compared to information-only control group.

Main outcome measures: Incremental cost analysis of variable costs from the pharmacy perspective captured prospectively at the participant level. Outcomes (effect measures) were 6-month refill adherence, changes in systolic blood pressure (SBP) and diastolic blood pressure (DBP), and proportion of patients achieving blood pressure (BP) control.

Results: Mean cost of intervention personnel time and tools was $104.8 ± $45.2. Incremental variable costs per millimeter of mercury decrease in SBP and DBP were $22.2 ± 16.3 and $66.0 ± 228.4, respectively. The cost of helping 1 more person achieve the BP goal (<140/90 mm Hg) was $665.2 ± 265.2; the cost of helping 1 more person achieve good refill adherence was $463.3 ± 110.7. Prescription drug costs were higher for the TEAM group ($392.8 [SD = 396.3] versus $307.0 [SD = 295.2]; P = 0.02). The startup cost for pharmacy furniture, equipment, and privacy screen was $168 per pharmacy.

Conclusion: Our randomized, practice-based intervention demonstrates that community pharmacists can implement a cost-effective intervention to improve hypertension control in blacks. This approach imposes a nominal expense at the pharmacy level that can be integrated into the ongoing pharmacist-patient relationship, and can enhance clinical and behavioral outcomes.

Trial registration: ClinicalTrials.gov NCT00205153.

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Conflict of interest statement

Disclosure: The authors declare no conflicts of interest or financial interests in any product or service mentioned in this article, including grants, employment, gifts, stock holdings, or honoraria.

Figures

Figure 1
Figure 1
Patient Flow in the Cost Analysis of TEAM Intervention
See this image and copyright information in PMC

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