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Cost-effectiveness evaluation of a home blood pressure monitoring program
Sarah J Billups1, Lindsy R Moore, Kari L Olson
116601 Centretech Pkwy, Aurora, CO 80011.
Insights
A home blood pressure monitoring (HBPM) program significantly improves blood pressure control in hypertensive patients. While requiring initial investment, HBPM offers a cost-effective strategy for managing hypertension long-term.
Area of Science:
- Health Economics
- Cardiovascular Medicine
- Health Services Research
Background:
- Hypertension management is crucial for preventing cardiovascular disease.
- Integrated healthcare systems seek cost-effective interventions for chronic disease management.
- Home blood pressure monitoring (HBPM) offers a potential alternative to usual care.
Purpose of the Study:
- To evaluate the health system cost-effectiveness of a home blood pressure monitoring (HBPM) program compared to usual care.
- To determine the incremental costs associated with HBPM per unit of blood pressure reduction and per patient achieving control.
Main Methods:
- A cost-effectiveness analysis was conducted using data from a randomized controlled trial of 348 hypertensive patients.
- Direct healthcare costs from a health plan perspective were compared between HBPM and usual care groups.
- Outcomes included changes in systolic blood pressure, blood pressure control rates, and life-years gained.
Main Results:
- The HBPM program resulted in significantly greater systolic blood pressure reduction (21 vs 8 mm Hg) and higher BP control rates (54% vs 35%).
- Median hypertension-related costs were higher in the HBPM group ($455 vs $179) due to increased encounters, medications, and monitoring.
- The HBPM program's cost per life-year gained was $3330.
Conclusions:
- The home blood pressure monitoring (HBPM) program necessitates increased investment in outpatient services, medications, and laboratory tests.
- Despite higher initial costs, HBPM demonstrates significantly improved blood pressure control, indicating potential long-term value.
- HBPM represents a valuable, albeit resource-intensive, strategy for enhancing hypertension management within integrated healthcare systems.
Objectives:
To evaluate the health system cost of a home blood pressure monitoring (HBPM) program versus usual care in an integrated healthcare system.
Study Design:
This cost-effectiveness analysis was based upon a previously completed randomized controlled trial of 348 hypertensive patients, in which mean systolic blood pressure (BP) was lowered 21 versus 8 mm Hg in the HBPM and usual care groups, respectively, and BP control was achieved in 54% versus 35% of patients (P < .001).
Methods:
This analysis compared direct costs from the health plan perspective, including clinic visits, e-mail and telephone encounters, laboratory tests, medications, hospitalizations, and emergency department visits between the 2 groups. Primary outcomes were the incremental hypertension care-related cost of HBPM per mm Hg lowering of systolic BP per patient, per additional BP controlled, and per life-year gained.
Results:
Median hypertension-related cost per patient over 6 months was $455 in the HBPM group and $179 for usual care (P < .001). This increase was attributable to additional e-mail and telephone encounters, greater antihypertensive medication use, additional laboratory monitoring, and the BP monitor. Median total cost per patient was $1530 and $1283 for the HBPM and usual care groups, respectively (P = .034). The HBPM program increased hypertension-related expenditures by $20.50 per mm Hg lowering of systolic BP, $1331 per additional patient achieving BP control at 6 months, and $3330 per life-year gained.
Conclusions:
The HBPM program requires investment in outpatient encounters, medications, and laboratory monitoring, but produces significantly improved BP control.
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Prepare for the Procedure:
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Monitoring BP in both arms during the initial assessment is advisable, as the systolic value may differ by five to ten mm Hg between arms. For subsequent BP assessments, use the arm with the higher reading.
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