Cost Effectiveness of a Cultural Physical Activity Intervention to Reduce Blood Pressure Among Native Hawaiians with Hypertension

Ashley F Railey; Clemma Muller; Carolyn Noonan; Maureen Schmitter-Edgecombe; Ka'imi Sinclair; Corin Kim; Mele Look; J Keawe'aimoku Kaholokula

doi:10.1007/s41669-021-00291-6

Cost Effectiveness of a Cultural Physical Activity Intervention to Reduce Blood Pressure Among Native Hawaiians with Hypertension

Pharmacoecon Open. 2022 Jan;6(1):85-94. doi: 10.1007/s41669-021-00291-6. Epub 2021 Aug 13.

Authors

Ashley F Railey^{1

2}, Clemma Muller³, Carolyn Noonan³, Maureen Schmitter-Edgecombe⁴, Ka'imi Sinclair³, Corin Kim⁵, Mele Look⁶, J Keawe'aimoku Kaholokula⁶

Affiliations

¹ Institute for Research and Education to Advance Community Health (IREACH), Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA. arailey@iu.edu.
² Department of Sociology, Indiana University, 1022 E. Third St, Bloomington, IN, 47405-7103, USA. arailey@iu.edu.
³ Institute for Research and Education to Advance Community Health (IREACH), Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA.
⁴ Department of Psychology, Washington State University, Pullman, WA, USA.
⁵ Kilohana, University of Hawai'i at Hilo, Hilo, HI, USA.
⁶ Department of Native Health, John A. Burns School of Medicine, University of Hawai'i at Mānoa, Mānoa, HI, USA.

Abstract

Objective: The aim of this study was to calculate the costs and assess whether a culturally grounded physical activity intervention offered through community-based organizations is cost effective in reducing blood pressure among Native Hawaiian adults with hypertension.

Methods: Six community-based organizations in Hawai'i completed a randomized controlled trial between 2015 and 2019. Overall, 263 Native Hawaiian adults with uncontrolled hypertension (≥ 140 mmHg systolic, ≥ 90 mmHg diastolic) were randomized to either a 12-month intervention group of hula (traditional Hawaiian dance) lessons and self-regulation classes, or to an education-only waitlist control group. The primary outcome was change in systolic blood pressure collected at baseline and 3, 6, and 12 months for the intervention compared with the control group. Incremental cost-effectiveness ratios (ICERs) were calculated for primary and secondary outcomes. Non-parametric bootstrapping and sensitivity analyses evaluated uncertainty in parameters and outcomes.

Results: The mean intervention cost was US$361/person, and the 6-month ICER was US$103/mmHg reduction in systolic blood pressure and US$95/mmHg in diastolic blood pressure. At 12 months, the intervention group maintained reductions in blood pressure, which exceeded reductions for usual care based on blood pressure outcomes. The change in blood pressure at 12 months resulted in ICERs of US$100/mmHg reduction in systolic blood pressure and US$93/mmHg in diastolic blood pressure. Sensitivity analyses suggested that at the estimated intervention cost, the probability that the program would lower systolic blood pressure by 5 mmHg was 67 and 2.5% at 6 and 12 months, respectively.

Conclusion: The 6-month Ola Hou program may be cost effective for low-resource community-based organizations. Maintenance of blood pressure reductions at 6 and 12 months in the intervention group contributed to potential cost effectiveness. Future studies should further evaluate the cost effectiveness of indigenous physical activity programs in similar settings and by modeling lifetime costs and quality-adjusted life-years.

Trial registration number: NCT02620709.

Associated data

ClinicalTrials.gov/NCT02620709

Abstract

Associated data

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