Barbershop intervention for hypertension may be cost-effective
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An intervention for uncontrolled hypertension in the setting of a barbershop may be a cost-effective strategy to improve systolic BP control among Black men, according to data published in Circulation.
“Health care interventions delivered in community settings outside of the traditional medical clinic that leverage established relationships may overcome mistrust due to racism in the health care system and improve health outcomes in Black men,” Kelsey B. Bryant, MD, MPH, MS, postdoctoral clinical fellow in the department of medicine and assistant in clinical medicine at NewYork-Presbyterian/Columbia University Irving Medical Center, and colleagues wrote. “The Los Angeles Barbershop Blood Pressure Study (LABBPS) built upon barber-patron relationships and teamwork between barbers and clinical pharmacists to deliver hypertension care in Los Angeles County Black barbershops.”
For LABBPS, a pharmacist-led treatment for hypertension care provided at Black-owned barbershops in Los Angeles County improved BP control among Black men with uncontrolled hypertension at baseline.
As Healio previously reported, health promotion in a barbershop setting to target uncontrolled hypertension led to a 21.6 mm Hg greater reduction in systolic BP compared with controls (95% CI, 14.7-28.4; P < .001).
For a cost-effectiveness analysis of the LABBPS, researchers conducted a 10-year event simulation that predicted BP, medication-related adverse events, fatal and nonfatal CVD events and non-CVD death among study participants. The researchers estimated program costs, total direct health care costs and quality-adjusted life-years.
Researchers discounted future costs and QALYs 3% annually. High cost-effectiveness was defined as less than $50,000 per QALY gained, and intermediate cost-effectiveness was defined as less than $150,000 per QALY gained.
Bryant and colleagues found that, at 10 years, the barbershop intervention was projected to cost an average of $2,356 more per participant compared with the control arm (95% uncertainty interval, 264 to 4,611) and gained 0.06 more QALYs (95% UI, 0.01-0.1).
According to the simulation analysis, the barbershop intervention was highly cost-effective, with a mean cost of $42,717 per QALY gained. Researchers estimated a 58% probability of the intervention being highly cost-effective and a 96% chance of being intermediately cost-effective.
Cost-effectiveness improved to $17,162 per QALY gained when the simulation was limited to the exclusive use of generic drugs.
Moreover, the barbershop intervention for hypertension was only considered intermediately cost-effective if pharmacists did not intensify antihypertensive medications when systolic BP was 150 mm Hg or greater or if the pharmacists’ commute to the barbershops were longer.
“Cost-effectiveness estimated for the LABBPS may not be generalizable to other U.S. communities, as it was specific to Los Angeles County and was driven in part by the high underlying risk of cardiovascular disease in Black men,” the researchers wrote. “It is unknown how an intervention like LABBPS might impact Black men in different locations across the U.S. However, the main results and exploratory analyses provide a useful framework to guide implementation of the LABBPS intervention and other community-based hypertension control interventions on a larger scale.”
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