Cost-Effectiveness of Hypertension Treatment by Pharmacists in Black Barbershops

Circulation. 2021 Jun 15;143(24):2384-2394. doi: 10.1161/CIRCULATIONAHA.120.051683. Epub 2021 Apr 15.


Background: In LABBPS (Los Angeles Barbershop Blood Pressure Study), pharmacist-led hypertension care in Los Angeles County Black-owned barbershops significantly improved blood pressure control in non-Hispanic Black men with uncontrolled hypertension at baseline. In this analysis, 10-year health outcomes and health care costs of 1 year of the LABBPS intervention versus control are projected.

Methods: A discrete event simulation of hypertension care processes projected blood pressure, medication-related adverse events, fatal and nonfatal cardiovascular disease events, and noncardiovascular disease death in LABBPS participants. Program costs, total direct health care costs (2019 US dollars), and quality-adjusted life-years (QALYs) were estimated for the LABBPS intervention and control arms from a health care sector perspective over a 10-year horizon. Future costs and QALYs were discounted 3% annually. High and intermediate cost-effectiveness thresholds were defined as <$50 000 and <$150 000 per QALY gained, respectively.

Results: At 10 years, the intervention was projected to cost an average of $2356 (95% uncertainty interval, -$264 to $4611) more per participant than the control arm and gain 0.06 (95% uncertainty interval, 0.01-0.10) QALYs. The LABBPS intervention was highly cost-effective, with a mean cost of $42 717 per QALY gained (58% probability of being highly and 96% of being at least intermediately cost-effective). Exclusive use of generic drugs improved the cost-effectiveness to $17 162 per QALY gained. The LABBPS intervention would be only intermediately cost-effective if pharmacists were less likely to intensify antihypertensive medications when systolic blood pressure was ≥150 mm Hg or if pharmacist weekly time driving to barbershops increased.

Conclusions: Hypertension care delivered by clinical pharmacists in Black barbershops is a highly cost-effective way to improve blood pressure control in Black men.

Keywords: barbering; blood pressure; cost-benefit analysis; hypertension.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Antihypertensive Agents / economics*
  • Antihypertensive Agents / pharmacology
  • Antihypertensive Agents / therapeutic use
  • Barbering
  • Black or African American
  • Blood Pressure / drug effects
  • Cost-Benefit Analysis*
  • Drug Administration Schedule
  • Drugs, Generic / economics
  • Drugs, Generic / therapeutic use
  • Humans
  • Hypertension / drug therapy
  • Male
  • Middle Aged
  • Pharmacists / psychology
  • Quality-Adjusted Life Years


  • Antihypertensive Agents
  • Drugs, Generic