Table 2.
Health and Economic Outcomes from Broad-Scale TBC Adoption Across the U.S. Population
| Variables | Standard care | Standard care with TBC | 10-Year difference | 95% CI |
|---|---|---|---|---|
| All ages (35+ years) | ||||
| At 10 years | ||||
| Mean SBP, mmHg, treated persons | 138.7 | 136.4 | −2.25 | −2.27, −2.23 |
| % Treated above goal | 42.3 | 32.0 | −10.3 | −10.5, −10.1 |
| Persons above goal (millions) | 35.2 | 30.5 | −4.72 | −4.82, −4.62 |
| Over 10 years | ||||
| Person-years above goal (millions) | 325.1 | 277.3 | −47.8 | −48.4, −47.3 |
| Incident MI (thousands) | 7,602 | 7,471 | −131.2 | −147.2, −115.2 |
| Incident stroke (thousands) | 5,391 | 5,187 | −203.9 | −223.0, −184.9 |
| Incident CVD events (thousands) | 30,128 | 29,490 | −638.0 | −674.4, −601.6 |
| Incident CVD death (thousands) | 7,789 | 7,624 | −164.7 | −180.7, −148.6 |
| Total QALYs (thousands) | 1,664,056 | 1,664,979 | 922.6 | 858.7, 986.5 |
| Total CVD costs, (billions US$) | 2,650 | 2,624 | −25.29 | −27.08, −23.51 |
| Private insurance CVD costs (billions US$) | 800 | 795 | −4.28 | −5.21, −3.35 |
| Medicare CVD costs (billions US$) | 1,423 | 1,404 | −19.38 | −20.79, −17.98 |
| Medicaid CVD costs (billions US$) | 263 | 262 | −0.82 | −1.10, −0.55 |
| Uninsured CVD costs (billions US$) | 94 | 94 | −0.54 | −0.68, −0.40 |
| Other insurer CVD costs (billions US$) | 70 | 70 | −0.27 | −0.41, −0.13 |
| Total productivity (billions US$) | 93,232 | 93,243 | 11.05 | 9.70, 12.39 |
| Aged 35–64 years | ||||
| At 10 years | ||||
| Mean SBP, treated persons, mmHg | 136.7 | 134.9 | −1.86 | −1.89, −1.83 |
| % Treated above goal | 35.0 | 25.3 | −9.8 | −10.1, −9.4 |
| Persons above goal (millions) | 14.4 | 12.6 | −1.81 | −1.87, −1.75 |
| Over 10 years | ||||
| Person-years above goal (millions) | 150.9 | 129.8 | −21.2 | −21.6, −20.8 |
| Incident MI (thousands) | 3,103 | 3,069 | −34.8 | −44.6, −25.0 |
| Incident stroke (thousands) | 1,261 | 1,237 | −24.4 | −32.5, −16.4 |
| Incident CVD events (thousands) | 10,919 | 10,807 | −111.3 | −129.3, −93.3 |
| Incident CVD death (thousands) | 2,016 | 1,995 | −21.0 | −28.3, −13.7 |
| Total QALYs (thousands) | 1,231,672 | 1,231,772 | 100.2 | 77.3, 123.0 |
| Total CVD costs (billions US$) | 1,250 | 1,245 | −5.36 | −6.38, −4.34 |
| Private insurance CVD costs (billions US$) | 741 | 737 | −3.48 | −4.37, −2.58 |
| Medicare CVD costs (billions US$) | 113 | 112 | −0.64 | −0.85, −0.43 |
| Medicaid CVD costs (billions US$) | 258 | 257 | −0.78 | −1.05, −0.51 |
| Uninsured CVD costs (billions US$) | 74 | 74 | −0.25 | −0.34, −0.15 |
| Other insurer CVD costs (billions US$) | 65 | 65 | −0.21 | −0.33, −0.09 |
| Total productivity (billions US$) | 82,824 | 82,825 | 1.66 | 0.96, 42.36 |
| Aged 65+ years | ||||
| At 10 years | ||||
| Mean SBP, treated persons, mmHg | 140.0 | 137.4 | −2.52 | −2.54, −2.50 |
| % Treated above goal | 47.1 | 36.5 | −10.6 | −10.9, −10.3 |
| Persons above goal (millions) | 20.8 | 17.9 | −2.91 | −2.99, −2.84 |
| Over 10 years | ||||
| Person-years above goal (millions) | 174.2 | 147.5 | −26.7 | −27.0, −26.3 |
| Incident MI (thousands) | 4,499 | 4,403 | −96.4 | − 109.0, −83.8 |
| Incident stroke (thousands) | 4,130 | 3,950 | −179.5 | −196.8, −162.3 |
| Incident CVD events (thousands) | 19,210 | 18,683 | −526.7 | −558.3, −495.1 |
| Incident CVD death (thousands) | 5,773 | 5,630 | −143.7 | −158.1, −129.3 |
| Total QALYs (thousands) | 432,385 | 433,207 | 822.4 | 763.5, 881.3 |
| Total CVD costs (billions US$) | 1,400 | 1,380 | −19.93 | −21.35, −18.51 |
| Private insurance CVD costs (billions US$) | 59 | 58 | −0.80 | −1.05, −0.56 |
| Medicare CVD costs (billions US$) | 1,310 | 1,291 | −18.74 | −20.13, −17.36 |
| Medicaid CVD costs (billions US$) | 5 | 5 | −0.04 | −0.07, −0.01 |
| Uninsured CVD costs (billions US$) | 20 | 20 | −0.29 | −0.40, −0.19 |
| Other Insurer CVD costs (billions US$) | 5 | 5 | −0.05 | −0.12, 0.01 |
| Total productivity (billions US$) | 10,409 | 10,418 | 9.39 | 8.26, 10.52 |
Note: The incident CVD events rows combine incident MI, incident stroke, incident hospitalization for congestive heart failure, onset of angina pectoris, and onset of intermittent claudication. The 95% CI is based on a simulation of 1 million persons. All costs are presented in undiscounted 2012 U.S. dollars.
CVD, cardiovascular disease; MI, myocardial infarction; SBP, systolic blood pressure; Stroke, ischemic and hemorrhagic stroke; QALYs, quality-adjusted life years; TBC, team-based care for hypertension.