JMIR Publications

ABSTRACT

Background:

Telehealth interventions have been shown to be effective in hypertension management. However, the cost-effectiveness of using telehealth interventions for managing hypertension patients remains inconclusive. Moreover, existing evidence often stems from experimental settings. Further research is required to understand the effectiveness and cost-effectiveness in the real-world setting.

Objective:

The Primary Technology-Enhanced Care for Hypertension (PTEC-HT) Scaling Programme, a telehealth intervention for hypertension management, is currently being scaled nationwide in Singapore. The programme comprises of remote blood pressure monitoring at home, healthcare team support through tele-consultations, and in-app support with timely and interactive chatbot. This study aimed to evaluate the effectiveness and cost-effectiveness of the programme.

Methods:

For patients under PTEC-HT Scaling programme, blood pressure (BP) readings over 6 months and 12 months, age, and gender were collected within the programme. Healthcare utilization, healthcare cost, and patient ethnicity were extracted from National Healthcare Group Polyclinics. For patients under usual-care group, demographic information, clinical data, healthcare utilization, and healthcare cost were extracted from the national claims records. Comparing PTEC-HT Scaling programme with usual care, an economic evaluation using patient-level data was conducted to examine the effectiveness and cost-effective over time horizons of 6 months and 12 months. Healthcare system’s perspective was adopted. Regression analysis and exact matching were used to control for the differences between the PTEC-HT group and usual-care group.

Results:

For 6th-month analysis, 427 patients were included in the PTEC-HT group and 64,679 patients were included in the usual-care group. For 12th-month analysis, 338 patients were included in the PTEC-HT group and 7,324 patients were included in the usual-care group. Using exact matching plus regression, in 6th-month analysis, the probability of having controlled BP was 13.5% (95%-CI: 6.3% - 20.7%) higher for the PTEC-HT group compared to the usual-care group. The direct medical cost was S$66.2 (95%-CI: 62.9 - 69.5) lower for the PTEC-HT group. In 12th-month analysis, the probability of having controlled BP was 16.0% (95%-CI: 10.7% - 21.3%) higher for the PTEC-HT group compared to the usual-care group. The direct medical cost was S$185.4 (95%-CI: 166.4 - 204.3) lower for the PTEC-HT group. Improvement in BP status mainly happened in the first 6 months. Saving in direct medical cost continued beyond first 6 months.

Conclusions:

Implemented in a real-world setting in Singapore, our study showed that PTEC-HT Scaling Programme is more effective in controlling BP status with lower direct medical cost compared to the usual care over both 6 months and 12 months.