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A Systematic Review of Economic Evidence on Community Hypertension Interventions

, PhD 1 , , PhD 2 , , PhD 3

American journal of preventive medicine

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      Abstract

      Context

      Effective community-based interventions are available to control hypertension. It is important to determine the economics of these interventions.

      Evidence acquisition

      Peer-reviewed studies from January 1995 through December 2015 were screened. Interventions were categorized into educational interventions, self-monitoring interventions, and screening interventions. Incremental cost-effectiveness ratios were summarized by types of interventions. The review was conducted in 2016.

      Evidence synthesis

      Thirty-four articles were included in the review (16 from the U.S., 18 from other countries), including 25 on educational interventions, three on self-monitoring interventions, and six on screening interventions. In the U.S., five (31.3%) studies on educational interventions were cost saving. Among the studies that found the interventions cost effective, the median incremental costs were $62 (range, $40–$114) for 1-mmHg reduction in systolic blood pressure (SBP) and $13,986 (range, $6,683–$58,610) for 1 life-year gained. Outside the U.S., educational interventions cost from $0.62 (China) to $29 (Pakistan) for 1-mmHg reduction in SBP. Self-monitoring interventions, evaluated in the U.S. only, cost $727 for 1-mmHg reduction in SBP and $41,927 for 1 life-year gained. For 1 quality-adjusted life-year, screening interventions cost from $21,734 to $56,750 in the U.S., $613 to $5,637 in Australia, and $7,000 to $18,000 in China. Intervention costs to reduce 1 mmHg blood pressure or 1 quality-adjusted life-year were higher in the U.S. than in other countries.

      Conclusions

      Most studies found that the three types of interventions were either cost effective or cost saving. Quality of economic studies should be improved to confirm the findings.

      Related collections

      Most cited references 48

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      Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.

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        Explaining the decrease in U.S. deaths from coronary disease, 1980-2000.

        Mortality from coronary heart disease in the United States has decreased substantially in recent decades. We conducted a study to determine how much of this decrease could be explained by the use of medical and surgical treatments as opposed to changes in cardiovascular risk factors. We applied a previously validated statistical model, IMPACT, to data on the use and effectiveness of specific cardiac treatments and on changes in risk factors between 1980 and 2000 among U.S. adults 25 to 84 years old. The difference between the observed and expected number of deaths from coronary heart disease in 2000 was distributed among the treatments and risk factors included in the analyses. From 1980 through 2000, the age-adjusted death rate for coronary heart disease fell from 542.9 to 266.8 deaths per 100,000 population among men and from 263.3 to 134.4 deaths per 100,000 population among women, resulting in 341,745 fewer deaths from coronary heart disease in 2000. Approximately 47% of this decrease was attributed to treatments, including secondary preventive therapies after myocardial infarction or revascularization (11%), initial treatments for acute myocardial infarction or unstable angina (10%), treatments for heart failure (9%), revascularization for chronic angina (5%), and other therapies (12%). Approximately 44% was attributed to changes in risk factors, including reductions in total cholesterol (24%), systolic blood pressure (20%), smoking prevalence (12%), and physical inactivity (5%), although these reductions were partially offset by increases in the body-mass index and the prevalence of diabetes, which accounted for an increased number of deaths (8% and 10%, respectively). Approximately half the decline in U.S. deaths from coronary heart disease from 1980 through 2000 may be attributable to reductions in major risk factors and approximately half to evidence-based medical therapies. Copyright 2007 Massachusetts Medical Society.
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          Executive Summary: Heart Disease and Stroke Statistics--2016 Update: A Report From the American Heart Association.

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            Author and article information

            Affiliations
            [1 ]Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, Georgia
            [2 ]Division for Heart Disease and Stroke Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
            [3 ]Division of Global Migration and Quarantine, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
            Author notes
            Address correspondence to: Donglan Zhang, PhD, Department of Health Policy and Management, College of Public Health, University of Georgia, 205D Wright Hall, 100 Foster Road, Athens GA 30677. dzhang@ 123456uga.edu
            Journal
            8704773
            1656
            Am J Prev Med
            Am J Prev Med
            American journal of preventive medicine
            0749-3797
            1873-2607
            13 February 2018
            December 2017
            20 February 2018
            : 53
            : 6 Suppl 2
            : S121-S130
            29153113 5819001 10.1016/j.amepre.2017.05.008 HHSPA939662

            This is an open access article under the CC BY-NC-ND license ( http://creativecommons.org/licenses/by-nc-nd/4.0/).

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