Cost-effectiveness of implementing a home blood pressure telemonitoring program

To evaluate the 12-month cost-effectiveness of the implementation of a home blood pressure telemonitoring (HBPT) program in a large US integrated health care system.

Retrospective cohort study.

Data from patients enrolled in the Kaiser Permanente Southern California HBPT program (November 2019-June 2022) were analyzed. We estimated program implementation costs and hypertension-related health care utilization and costs (in 2020 US$) 12 months pre- and post HBPT program enrollment. We compared 12-month costs and blood pressure (BP) outcomes between patients who participated in the program and those who abandoned it prior to participation, using inverse probability of treatment weights to adjust for baseline characteristics. A difference-in-differences analysis estimated mean differences in outcomes associated with the HBPT program. Incremental cost-effectiveness ratios (cost per mm Hg reduction) were calculated with 95% bootstrapped CIs.

The study included 3067 patients (mean age, 56.7 years; 62.7% female; 62.1% non-Hispanic Black). HBPT program implementation costs averaged $113.35 per patient. The program reduced hypertension-related office visit costs (-$6.52; P = .016) and BP clinic visit costs (-$2.58; P = .002), despite an increase in hypertension-related virtual encounter costs ($11.80; P < .001). Mean BP reductions were 1.42 mm Hg (P = .071) for systolic BP (SBP) and 1.58 mm Hg (P = .001) for diastolic BP (DBP). Incremental cost-effectiveness ratios were $81.67 per mm Hg SBP reduction and $73.22 per mm Hg DBP reduction.

The HBPT program in a real-world clinical setting achieved modest BP reductions, although overall costs increased primarily due to enrollment expenses.