Cost Effectiveness of a Cultural Physical Activity Intervention to Reduce Blood Pressure Among Native Hawaiians with Hypertension

Abstract

Objective: The aim of this study was to calculate the costs and assess whether a culturally grounded physical activity intervention offered through community-based organizations is cost effective in reducing blood pressure among Native Hawaiian adults with hypertension.

Methods: Six community-based organizations in Hawai'i completed a randomized controlled trial between 2015 and 2019. Overall, 263 Native Hawaiian adults with uncontrolled hypertension (≥ 140 mmHg systolic, ≥ 90 mmHg diastolic) were randomized to either a 12-month intervention group of hula (traditional Hawaiian dance) lessons and self-regulation classes, or to an education-only waitlist control group. The primary outcome was change in systolic blood pressure collected at baseline and 3, 6, and 12 months for the intervention compared with the control group. Incremental cost-effectiveness ratios (ICERs) were calculated for primary and secondary outcomes. Non-parametric bootstrapping and sensitivity analyses evaluated uncertainty in parameters and outcomes.

Results: The mean intervention cost was US$361/person, and the 6-month ICER was US$103/mmHg reduction in systolic blood pressure and US$95/mmHg in diastolic blood pressure. At 12 months, the intervention group maintained reductions in blood pressure, which exceeded reductions for usual care based on blood pressure outcomes. The change in blood pressure at 12 months resulted in ICERs of US$100/mmHg reduction in systolic blood pressure and US$93/mmHg in diastolic blood pressure. Sensitivity analyses suggested that at the estimated intervention cost, the probability that the program would lower systolic blood pressure by 5 mmHg was 67 and 2.5% at 6 and 12 months, respectively.

Conclusion: The 6-month Ola Hou program may be cost effective for low-resource community-based organizations. Maintenance of blood pressure reductions at 6 and 12 months in the intervention group contributed to potential cost effectiveness. Future studies should further evaluate the cost effectiveness of indigenous physical activity programs in similar settings and by modeling lifetime costs and quality-adjusted life-years.

Trial registration number: NCT02620709.

Fig. 1

Uncertainty and sensitivity analyses for costs and incremental cost effectiveness by time period (systolic blood pressure). Reported average class size of 10 people. Bootstrap estimates using ± 20% range for costs. Cost per difference in the reduction of systolic blood pressure between the Ola Hou and control groups. Costs and effectiveness are incremental. mmHg millimeter of mercury, US$ United States dollars, ICER incremental cost-effectiveness ratio

Fig. 2

Uncertainty and sensitivity analyses for costs and incremental cost effectiveness by time period and class size (systolic blood pressure). Bootstrap estimates using ± 20% range for costs. Cost per difference in the reduction of systolic blood pressure between the Ola Hou and control groups. Costs and effectiveness are incremental. Class sizes are based on reported expected class sizes (5, 10, 15, and 20). mmHg millimeter of mercury, US$ United States dollars.