The cost-effectiveness of pharmacist-physician collaborative care models vs usual care on time in target systolic blood pressure range in patients with hypertension: a payer perspective

The purpose of this study was to investigate whether a protocol for permissive hypotension was feasible for patients admitted with a ruptured abdominal aortic aneurysm (RAAA). It was aimed to limit prehospital intravenous fluid administration to 500 mL and to maintain systolic blood pressure at a range of 50 to 100 mm Hg following admission, using nitrates when indicated. The diagnosis of RAAA was confirmed with sonography, and all patients with uncontrolled hypovolemic shock immediately underwent open aneurysm repair (OAR). In all other cases, computed tomographic (CT) angiography was performed to determine the eligibility for endovascular aneurysm repair (EVAR). From January 1, 2004, to December 31, 2006, 95 patients with a suspected RAAA were admitted. In 77 patients, the diagnosis of RAAA was confirmed. Twenty-eight cases (36%) underwent OAR for uncontrolled hemodynamic instability. Following CT-angiographic evaluation, 25 of the remaining 49 cases were considered unsuitable for EVAR and subsequently underwent OAR. In 24 of 77 cases (31%), the RAAA was treated with EVAR. Preoperative systolic blood pressure recordings in EVAR patients showed median values (± SD) of 98 (± 34.7) mm Hg in the emergency department and 114 (± 26.2) mm Hg in the operating theater. The desired systolic blood pressure range of 50 to 100 mm Hg was reached in 11 of 24 cases (46%). In 13 of 24 cases (54%), a systolic blood pressure higher than 100 mm Hg was recorded for a period longer than 60 minutes. The 30-day mortality was 32 of 77 (42%), with 6 of 24 (25%) in the EVAR group and 26 of 53 (49%) in the OAR group. This is the first published series of RAAA in which a protocol of permissive hypotension has been adopted. The concept appeared to be feasible in the majority of cases. Protocol violations were sparse ( n = 5). Uncontrolled hypotension occurred in 36% (28 of 77) of all patients, and the desired systolic blood pressure range was achieved in 46% (11 of 24) of the EVAR patients.

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Evaluation of Optimal Diastolic Blood Pressure Range Among Adults With Treated Systolic Blood Pressure Less Than 130 mm Hg

JAMA Network Open ◽

10.1001/jamanetworkopen.2020.37554 ◽

2021 ◽

Vol 4 (2) ◽

pp. e2037554

Author(s):

Jingen Li ◽

Virend K. Somers ◽

Xiang Gao ◽

Zhuo Chen ◽

Jianqing Ju ◽

...

Keyword(s):

Blood Pressure ◽

Systolic Blood Pressure ◽

Diastolic Blood Pressure ◽

Pressure Range ◽

Blood Pressure Range

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Intraoperative Systolic Blood Pressure Variability Predicts 30-day Mortality in Aortocoronary Bypass Surgery Patients

Anesthesiology ◽

10.1097/aln.0b013e3181e07ee9 ◽

2010 ◽

Vol 113 (2) ◽

pp. 305-312 ◽

Cited By ~ 64

Author(s):

Solomon Aronson ◽

Mark Stafford-Smith ◽

Barbara Phillips-Bute ◽

Andrew Shaw ◽

Jeffrey Gaca ◽

...

Keyword(s):

Blood Pressure ◽

Cardiac Surgery ◽

Systolic Blood Pressure ◽

Blood Pressure Variability ◽

Pressure Range ◽

Bypass Surgery ◽

Aortocoronary Bypass ◽

Aortocoronary Bypass Surgery ◽

Systolic Blood Pressure Variability ◽

Blood Pressure Range

Background Few data support an association between blood pressure variability and clinical outcomes during cardiac surgery. We tested the hypothesis that intraoperative systolic blood pressure variability outside a targeted blood pressure range predicts 30-day mortality in patients undergoing cardiac surgery. Methods Electronically captured blood pressure data from 7,504 consecutive coronary bypass surgery procedures between September 1, 1996, and December 31, 2005, were divided into development and validation cohorts. Systolic blood pressure variability episodes outside a blood pressure range (e.g., higher than 135 or lower than 95 mmHg) were characterized by number of episodes, magnitude of episode, duration of episode, and magnitude x duration of excursion (i.e., area under the curve). Multiple logistic regression analysis was used to assess 30-day mortality association. The most predictive mortality risk characteristic and blood pressure range was tested in the validation cohort. Results A total of 3.1 million intraoperative blood pressure evaluations were analyzed. Systolic blood pressure variability was derived in 5,038 patients and validated in 2,466 patients (8% without cardiopulmonary bypass and 6% with valve procedure). Among all tested indices of blood pressure variability, mean duration of systolic excursion (outside a range of 105-130 mmHg) was most predictive of 30-day mortality (odds ratio = 1.03 per minute, 95% CI 1.02-1.39, P < 0.0001). Conclusions Intraoperative blood pressure variability is associated with 30-day postoperative mortality in patients undergoing aortocoronary bypass surgery.

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Abstract 616: The Population Impact and Cost-Effectiveness of Blood Pressure Treatment in U.S. Adults Age 75 and Older

Hypertension ◽

10.1161/hyp.62.suppl_1.a616 ◽

2013 ◽

Vol 62 (suppl_1) ◽

Author(s):

Michelle C Odden ◽

Pamela Coxson ◽

Andrew Moran ◽

David Guzman ◽

Lee Goldman ◽

...

Keyword(s):

Blood Pressure ◽

Cost Effectiveness ◽

Side Effects ◽

Systolic Blood Pressure ◽

Blood Pressure Target ◽

Blood Pressure Treatment ◽

Artery Disease ◽

The Cost ◽

The Impact ◽

The U.S

Introduction: In the next 30 years, the population of adults 75 years and older will more than double in the U.S., and high blood pressure is the most prevalent cardiovascular risk factor in this population. The impact of strategies for blood pressure control has not been evaluated in this population with special consideration of geriatric conditions that may alter the cost-effectiveness. Methods: Based on the Cardiovascular Disease Policy Model, a Markov model of the U.S. population, we forecasted the population impact of blood pressure treatment over 10 years in adults aged 75-94 years, using the health care system perspective, and assuming an annual discount rate of 3%. Based on epidemiologic and trial data, we projected the impact of four potential negative events on cost-effectiveness in this geriatric population: 1) mild side effects, 2) polypharmacy (use of 5+ medications) associated cognitive impairment, 3) increased risk of falls/fracture, and 4) attenuated effectiveness of therapy in frail older adults Results: We project that treatment to a systolic blood pressure target of 160 mmHg would result in the prevention of 65,000 cases of incident coronary artery disease, and 54,000 cases of incident ischemic stroke in adults 74-95 years. Based on a systolic blood pressure target of 140 mmHg, 191,000 cases of incident coronary artery disease, and 141,000 cases of incident ischemic stroke would be avoided. This would result in 729,000 additional years of life and 992,000 quality-adjusted life years (QALYs). The total health care costs of treating 75-94 year olds to a systolic blood pressure target of 140 mmHg would be $40.5 billion in the U.S., and the cost per QALY would be $40,800. The cost-effectiveness of treatment to a target of 140 mmHg would be worse in the presence of side effects ($ 51,000/QALY), polypharmacy ($ 58,400), fractures ($ 48,400), or frailty ($134,300). Conclusions: Treatment of systolic blood pressure to a target of 140 mmHg would prevent the most cardiovascular events and result in the greatest QALYs gained. The presence of side effects, polypharmacy-related cognitive impairment, fractures, or frailty could substantially offset this benefit. Treatment strategies that are tailored to the health status of older adults are warranted.

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Impact of a pharmacist-physician collaborative care model on time-in-therapeutic blood pressure range in patients with hypertension

Journal of the American College of Clinical Pharmacy ◽

10.1002/jac5.1115 ◽

2019 ◽

Vol 3 (2) ◽

pp. 404-409

Author(s):

Dave L. Dixon ◽

Eric D. Parod ◽

Evan M. Sisson ◽

Benjamin W. Van Tassell ◽

Pramit A. Nadpara ◽

...

Keyword(s):

Blood Pressure ◽

Collaborative Care ◽

Pressure Range ◽

Care Model ◽

Collaborative Care Model ◽

Blood Pressure Range

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Cost-Effectiveness Analysis of A Program to Delay Progression to Dialysis and Death Among CKD Patients in Lima, Peru

10.21203/rs.3.rs-30267/v1 ◽

2020 ◽

Author(s):

Enrique M Saldarriaga ◽

Jessica Bravo-Zúñiga ◽

Yamilee Hurtado-Roca ◽

Víctor Suarez

Keyword(s):

Cost Effectiveness ◽

Cost Saving ◽

Usual Care ◽

Economic Value ◽

Management Intervention ◽

Lack Of Information ◽

Case Management Intervention ◽

Payer Perspective ◽

Life Years ◽

The Cost

Abstract Background. The Renal Health Program (RHP) was implemented in 2013 as a secondary prevention strategy to reduce the incidence of patients starting dialysis and overall mortality. A previous study found that adhered patients have 58% protection against progression to dialysis compared to non-adhered. Objective. We aim to estimate the lifetime economic and health consequences of the RHP intervention to determine its cost-effectiveness in comparison with usual care. Methods. We use a Markov model of three health stages to simulate for 30 years the cost associated with RHP and usual care, as well as years lived free of dialysis (YL) and Quality Adjusted Life Years (QALY). Costs were estimated from the payer perspective. We conduct a Probabilistic Sensitivity Analysis (PSA) to assess the robustness of our estimates. Results. We found that the RHP is a cost-saving alternative compared to usual care, with a per person difference of $-782.73in costs and 0.04 in QALYs. The Incremental Cost-Effectiveness Ratio (ICER) per QALY is $-21,660. From a PSA, RHP holds cost-saving under 999 out of 1,000 evaluated scenarios. Discussion. Our results show the lifetime economic value of a case-management intervention for CKD patients to delay its progression to dialysis. The RHP is cost-saving compared to usual care, with a negative ICER per QALY robust to different scenarios. We aim these results to help in the decision-making process of scaling-up and investment of similar strategies in Peru. Our results help to increase the evidence in Latin America where there is a lack of information in the long-term consequences of prevention and early referral strategies in CKD patients.

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Relationship between blood pressure and organ weight in the rat

American Journal of Physiology-Legacy Content ◽

10.1152/ajplegacy.1962.202.5.967 ◽

1962 ◽

Vol 202 (5) ◽

pp. 967-970 ◽

Cited By ~ 10

Author(s):

Melvin J. Fregly

Keyword(s):

Blood Pressure ◽

Systolic Blood Pressure ◽

Pressure Range ◽

Blood Pressure Level ◽

Weight Ratio ◽

Organ Weight ◽

Systolic Blood Pressure Level ◽

Blood Pressure Range ◽

The Relationship ◽

High Range

A relationship exists between systolic blood pressure and the organ to body weight ratios of heart, thyroid, adrenals, and kidneys. In the cases of heart, thyroid, and adrenals, the relationship is sigmoid in character, with the fast-rising portion of the curve beginning at a systolic blood pressure range of 150–159 mm Hg. Beginning at this same blood pressure range, kidney weight ratio increases linearly with increases in blood pressure. It is of interest that these changes occur at a blood pressure range which is generally considered to lie either at the high range of normotension or the low range of hypertension. The only organ weight ratio apparently unrelated to systolic blood pressure level is that of the testis. Some interrelationships among weight ratios of these organs were observed and are discussed.

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VOLUME–PRESSURE RELATIONSHIPS OF THE TURKEY AORTA

Canadian Journal of Physiology and Pharmacology ◽

10.1139/y66-112 ◽

1966 ◽

Vol 44 (6) ◽

pp. 901-907 ◽

Cited By ~ 10

Author(s):

Elwood W. Speckmann ◽

Robert K. Ringer

Keyword(s):

Blood Pressure ◽

Ascorbic Acid ◽

Systolic Blood Pressure ◽

Thoracic Aorta ◽

Abdominal Aorta ◽

Volume Change ◽

Pressure Range ◽

Pressure Curve ◽

Blood Pressure Range ◽

Thoracic And Abdominal

This experiment was an attempt to define the volume–pressure relationships of the untreated turkey aorta and to evaluate the effect on these relationships of treatment with beta-aminopropionitrile (BAPN) and ascorbic acid. Distensibility values (ΔV/ΔP) were calculated for each of three linear segments of the volume–pressure curve for treated and untreated thoracic and abdominal aortas. In general, the distensibility of the thoracic aorta was greater than that of the abdominal aorta. In both aortic segments addition of BAPN to the ration tended to increase, whereas the addition of ascorbic acid tended to decrease distensibility. The volume–pressure curve of the thoracic aorta was sigmoid in nature and demonstrated the greatest distensibility in the normal physiological systolic blood pressure range of the male Broad Breasted Bronze turkey. Both aortic segments exhibited hysteresis and an isobaric volume change upon successive loading. These phenomena decreased in magnitude with successive loadings.

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A Systematic Review of Cost-Effectiveness Analyses Alongside Randomised Controlled Trials of Acupuncture

Acupuncture in Medicine ◽

10.1136/acupmed-2012-010178 ◽

2012 ◽

Vol 30 (4) ◽

pp. 273-285 ◽

Cited By ~ 38

Author(s):

Song-Yi Kim ◽

Hyangsook Lee ◽

Younbyoung Chae ◽

Hi-Joon Park ◽

Hyejung Lee

Keyword(s):

Cost Effectiveness ◽

Usual Care ◽

Randomised Controlled Trials ◽

Risk Of Bias ◽

Economic Evaluations ◽

Controlled Trials ◽

German Studies ◽

Life Years ◽

Randomised Controlled ◽

The Cost

Objective To summarise the evidence on the cost-effectiveness of acupuncture. Methods We identified full economic evaluations such as cost-effectiveness analysis (CEA), cost-utility analysis (CUA) and cost-benefit analysis (CBA) alongside randomised controlled trials (RCTs) that assessed the consequences and costs of acupuncture for any medical condition. Eleven electronic databases were searched up to March 2011 without language restrictions. Eligible RCTs were assessed using the Cochrane criteria for risk of bias and a modified version of the checklist for economic evaluation. The general characteristics and the results of each economic analysis such as incremental cost-effectiveness ratios (ICERs) were extracted. Results Of 17 included studies, nine were CUAs that measured quality-adjusted life years (QALYs) and eight were CEAs that assessed effectiveness of acupuncture based on improvements in clinical symptoms. All CUAs showed that acupuncture with or without usual care was cost-effective compared with waiting list control or usual care alone, with ICERs ranging from ¢3011/QALY (dysmenorrhoea) to ¢22 298/QALY (allergic rhinitis) in German studies, and from £3855/QALY (osteoarthritis) to £9951/QALY (headache) in UK studies. In the CEAs, acupuncture was beneficial at a relatively low cost in six European and Asian studies. All CUAs were well-designed with a low risk of bias, but this was not the case for CEAs. Conclusions Overall, this review demonstrates the cost-effectiveness of acupuncture. Despite such promising results, any generalisation of these results needs to be made with caution given the diversity of diseases and the different status of acupuncture in the various countries.

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Cost-effectiveness of psychotherapy for cluster B personality disorders

The British Journal of Psychiatry ◽

10.1192/bjp.bp.109.070482 ◽

2010 ◽

Vol 196 (5) ◽

pp. 396-403 ◽

Cited By ~ 33

Author(s):

Djøra I. Soeteman ◽

Roel Verheul ◽

Jos Delimon ◽

Anke M. M. A. Meerman ◽

Ellen van den Eijnden ◽

...

Keyword(s):

Cost Effectiveness ◽

Personality Disorders ◽

Cost Effective ◽

Quality Adjusted Life Year ◽

Decision Analytic Model ◽

Day Hospital ◽

Payer Perspective ◽

Cluster B Personality Disorders ◽

Effective Choice ◽

The Cost

BackgroundRecommendations on current clinical guidelines are informed by limited economic evidence.AimsA formal economic evaluation of three modalities of psychotherapy for patients with cluster B personality disorders.MethodA probabilistic decision-analytic model to assess the cost-effectiveness of out-patient, day hospital and in-patient psychotherapy over 5 years in terms of cost per recovered patient-year and cost per quality-adjusted life-year (QALY). Analyses were conducted from both societal and payer perspectives.ResultsFrom the societal perspective, the most cost-effective choice switched from out-patient to day hospital psychotherapy at a threshold of €12 274 per recovered patient-year; and from day hospital to in-patient psychotherapy at €113 298. In terms of cost per QALY, the optimal strategy changed at €56 325 and €286 493 per QALY respectively. From the payer perspective, the switch points were at €9895 and €155 797 per recovered patient-year, and €43 427 and €561 188 per QALY.ConclusionsOut-patient psychotherapy and day hospital psychotherapy are the optimal treatments for patients with cluster B personality disorders in terms of cost per recovered patient-year and cost per QALY.

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