Table 2.
Markov model parameters and distributions
| Parameter | Value | Probabilistic | Source |
|---|---|---|---|
| Base case | |||
| Reduction in systolic blood pressure | −18.3 mmHg | Normal (–18.3, 1.2) Normal (–7.6, 0.69) |
Tsuyuki et al.10
Santschi et al.9 |
| Relative risk of cardiovascular disease in intervention group | 0.50 | Normal (0.50, 0.02) | BPL Treatment Trialists19 |
| Relative risk of renal disease in intervention group | 0.77 | Ratio: normal (2.6, 0.30)/normal (1.6, 0.25) | Hsu et al.15 |
| Hazard ratio for mortality after cardiovascular disease | 1.7 | Lognormal (0.538, 0.075) | Pocock et al.17 |
| Cost of pharmacist intervention | Assumption | ||
| Year 1 | $200.00 | ||
| Year 2 | $75.00 | ||
| Year 3+ | $50.00 | ||
| Cost of stroke | |||
| Year 1 | $79,925 | Gamma (197.02, 405.66) | Mittman et al.,20 Sorensen et al.21 |
| Year 2+ | $12,126 | Gamma (25, 485.03) | |
| Cost per year of heart failure | $13,240 | Gamma (25, 529.6) | Bentkover et al.22 |
| Cost per year of angina | $3,764 | Gamma (37.42, 100.58) | McGillion et al.23 |
| Cost of myocardial infarction | Coyle et al.24 | ||
| Year 1 | $11,511 | Gamma (25, 460.46) | |
| Year 2+ | $3,367 | Gamma (25, 134.68) | |
| Cost per year of end-stage renal disease | $66,837 | Gamma (25, 2673.46) | Manns et al.25 |
| Cost of background medical costs | $6,105 | Canadian Institutes for Health Information26 | |
| Utility | Sullivan et al.18 | ||
| General population | 0.867 | ||
| After stroke | 0.694 | Beta (7090, 3126) | |
| After heart failure | 0.636 | Beta (480, 275) | |
| After angina | 0.709 | Beta (4843, 1988) | |
| After myocardial infarction | 0.725 | Beta (61446, 23307) | |
| Post end-stage renal disease | 0.708 | Beta (1248, 515) | |
| Disutility per year after age 70 | 0.00029 | ||
| One-way sensitivity analyses | |||
| Framingham 30-year risk equations for blood pressure impact | Pencina et al.12 | ||
| Blood pressure reduction based on partial intervention | Santschi et al.9 | ||
| Age-specific background cost estimates | Canadian Institutes for Health Information26 | ||
| Reduced time horizon (5 years, 10 years) | Assumption | ||
| Cost of pharmacist intervention doubled and training costs added | Assumption | ||
| Reduction in background medical costs for intervention group | Assumption | ||
| Reduced efficacy of pharmacist intervention over time (effect decayed after 3 years, effect decayed after 10 years) | Assumption | ||
| “Optimistic” scenario regarding cost of full-scope intervention | Assumption | ||