The economic impact of the introduction of home blood pressure measurement for the diagnosis and treatment of hypertension.
OBJECTIVE
To investigate the economic consequences resulting from introduction of home blood pressure measurement in diagnosis of hypertension instead of casual clinic blood pressure measurement.


METHODS
We constructed a decision tree model using data from the Ohasama study and a Japanese national database. The Ohasama study provided the prognostic value of home blood pressure as compared with clinic blood pressure measurement.


RESULTS
It is predicted that the use of home blood pressure for hypertension diagnosis results in a saving of 9.30 billion US dollars (1013.6 billion yen) in hypertension-related medical costs in Japan. Most of this was attributable to medical costs saved by avoiding the start of treatment for untreated individuals who were diagnosed as hypertensive by clinic blood pressure but whose blood pressures were in the normal range when based on home blood pressure; that is, the so called white-coat hypertension. Furthermore, it could be expected that adequate blood pressure control mediated by the change in the diagnostic method from clinic to home blood pressure measurement would improve the prognosis for hypertension. We estimated that the prevention of hypertensive complications resulted in a reduction of annual medical costs by 28 million US dollars (3.0 billion yen). In addition, stroke prevention due to adequate blood pressure control based on home blood pressure measurement reduced annual long-term care costs by 39 million US dollars (4.2 billion yen). A per-person break-even cost for introducing home blood pressure monitoring was calculated as 409 US dollars (44,580 yen).


CONCLUSIONS
The introduction of home blood pressure measurement for the diagnosis and treatment of hypertension would be very effective to save costs.
Funahashi
Jin
J
Department of Clinical Pharmacology and Therapeutics, Tohoku University Graduate School of Pharmaceutical Science and Medicine, Tokyo, Japan.
Ohkubo
Takayoshi
T
Fukunaga
Hidefumi
H
Kikuya
Masahiro
M
Takada
Noriko
N
Asayama
Kei
K
Metoki
Hirohito
H
Obara
Taku
T
Inoue
Ryusuke
R
Hashimoto
Junichiro
J
Totsune
Kazuhito
K
Kobayashi
Makoto
M
Imai
Yutaka
Y
D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D018660:Blood Pressure Monitoring, Ambulatory / Q000191:economics*; D017046:Cost Savings; D016208:Databases, Factual; D003663:Decision Trees; D016903:Drug Monitoring / Q000191:economics / Q000379:methods; D005260:Female; D017048:Health Care Costs; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy / Q000191:economics; D007564:Japan; D008297:Male; D008875:Middle Aged; D017059:Models, Econometric; D017202:Myocardial Ischemia / Q000191:economics / Q000517:prevention & control; D011379:Prognosis; D012680:Sensitivity and Specificity; D020521:Stroke / Q000191:economics / Q000517:prevention & control
D000959:Antihypertensive Agents