Black Barbershops with Pharmacist-led Care can Combat Hypertension

Black and white image of a black man getting a haircut at a barbershop. Credit: BariKive from Pexels.

Black barbershops with pharmacist-led blood pressure (BP) care for their clients, have been shown to be cost effective, with the high initial costs offsetting reduced cardiovascular events later in life.

The study cost simulations were based on the original  Los Angeles Barbershop Blood Pressure Study (LABBPS). In that study, intervention consisted of a trial with men being assigned either to barbershops where barbers encouraged patrons to meet with pharmacists who prescribed drug therapy under an agreement with the participants’ doctors, with the control group being men assigned to barbershops where the barbers only promoted lifestyle modification and physician visits. This intervention resulted in a mean BP drop of 27.0mmHg compared to the control group which fell by 9.3mmHg.

In a 1-year intervention based on costs for the LABBPS, on average, $2356 more per participant than the controls and was associated with a gain of 0.06 quality-adjusted life years (QALYs) over a 10-year horizon, according to Brandon Bellows, PharmD, MS, of Columbia University in New York City, and colleagues.

Thus, in computer simulations,  the LABBPS intervention was associated with 10-year projected total healthcare costs averaging $42 717 per QALY gained, reported the researchers.

“One concern raised as a potential barrier to widespread LABBPS implementation is the specialty training of clinical pharmacists. In this analysis, the cost of specialty training and certification was included; the results suggest that long-term health benefits and avoided healthcare costs of the LABBPS offset these upfront training costs,” the researchers wrote.

The team reported that the cost effectiveness of the intervention could be increased under various various scenarios:

  • Only using generic drugs: $17 162 per QALY gained
  • Shortening intervention to 26 weeks: $18 300 per QALY gained
  • Implementing optimal savings from less time spent on intervention tasks, lower equipment costs, only using generics, and no participant incentive costs: intervention becomes dominant (both less expensive and more effective than control)

However, if pharmacists were less likely to intensify antihypertensive medications when systolic BP was ≥ 150 mm Hg, or if pharmacists took longer to get to the barbershops, the cost of the LABBPS intervention would exceed $50 000 per QALY gained.

“Hypertension care delivered by clinical pharmacists in Black barbershops is a highly cost-effective way to improve BP control in Black men,” the authors concluded.  

The LABBPS has received praise for demonstrating that Black men with uncontrolled hypertension had better BP control after 6 months with barbershop visits by specialty pharmacists than with regular physician visits. Extending the intervention to 1 year did not change the results.

Researchers previously reported that a telemedicine component could bring down cost and maintain efficiency of the LABBPS program.

“Hypertension prevalence remains higher among non-Hispanic Black men than in any other racial or ethnic group in the US. Hypertension awareness and treatment have plateaued in the US since 2010, and Black men continue to have worse BP control and higher hypertension-related cardiovascular disease mortality rates compared with other groups,” the investigators wrote.

The researchers assumed that after the one-year intervention period, processes of hypertension care management returned to standard care, which was a major limitation of the study.

“These findings may also be somewhat limited in scope as a healthcare sector perspective was used, which only considers direct healthcare costs, rather than a societal perspective, which may include indirect costs such as improvements in productivity,” noted Bellows and co-authors. “Finally, 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.”

Source: MedPage Today

Journal information: Bryant KB, et al “Cost-effectiveness of hypertension treatment by pharmacists in black barbershops” Circulation 2021; DOI: 10.1161/CIRCULATIONAHA.120.051683.