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

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. (C) 2016 American Pharmacists Association (R). Published by Elsevier Inc. All rights reserved.