Prerequisites for cost-effective Home Blood Pressure Telemonitoring: Insights from an early health economic analysis
ABSTRACT
Background:
Home Blood Pressure Telemonitoring (HBPT) has been proposed to enhance adherence and optimize healthcare delivery, yet its prerequisites for cost-effective implementation remain unclear.
Objective:
This study aims to quantify the potential cost-effectiveness of HBPT and identify prerequisites for cost-effective implementation of HBPT in comparison to standard hypertension management, using an early health economic analysis from a societal perspective.
Methods:
A decision analytic Markov model with a lifetime horizon (30 years) and a willingness-to-pay threshold of € 20,000 per quality-adjusted life year (QALY) was developed to assess the cost-effectiveness of HBPT compared to standard of care (SOC). The HBPT intervention was based on an existing HBPT program applied by the Maasstad Hospital, Rotterdam, the Netherlands. The model incorporated 12 health states including 7 blood pressure states, cardiovascular (CV) event, recurrent CV event, post recurrent CV event, all-cause death, and cardiovascular disease related death. A hypothetical cohort of 1,000 patients was modelled and results were reported in costs, QALYs and the incremental cost-effectiveness ratio (ICER). Extensive sensitivity analyses were performed to identify important variables for cost-effective implementation of HBPT.
Results:
Following the base-case analysis, HBPT was not cost-effective with an ICER of € 20,297 per QALY. Sensitivity analyses indicated that reducing the number of outpatient department (OPD) consultations results in a more favorable ICER. Specifically, reducing the number of OPD consultations to 1.48 annually resulted in an ICER below the WTP threshold. A reduction to an average of 1.18 consultations per year would make HBPT cost saving. Scenario analyses revealed that extending the duration of HBPT's clinical effect to two or three years substantiall y improved the ICER. Additionally, targeting HBPT towards patients aged 64 or below further improved the ICER.
Conclusions:
HBPT could result in cost-effective or even cost-saving outcomes with only minor reductions in OPD consultations. These findings highlight the potential of HBPT to transform hypertension management by replacing traditional hypertension management with more efficient care using remote patient monitoring. Clinical Trial: NA
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