Economic evaluation of home blood pressure monitoring with or without telephonic behavioral self-management in patients with hypertension.
BACKGROUND
The Take Control of Your Blood Pressure trial evaluated the effect of a multicomponent telephonic behavioral lifestyle intervention, patient self-monitoring, and both interventions combined compared with usual care on reducing systolic blood pressure during 24 months. The combined intervention led to a significant reduction in systolic blood pressure compared with usual care alone. We examined direct and patient time costs associated with each intervention.


METHODS
We conducted a prospective economic evaluation alongside a randomized controlled trial of 636 patients with hypertension participating in the study interventions. Medical costs were estimated using electronic data representing medical services delivered within the health system. Intervention-related costs were derived using information collected during the trial, administrative records, and published unit costs.


RESULTS
During 24 months, patients incurred a mean of $6,965 (s.d., $22,054) in inpatient costs and $8,676 (s.d., $9,368) in outpatient costs, with no significant differences among the intervention groups. With base-case assumptions, intervention costs were estimated at $90 (s.d., $2) for home blood pressure monitoring, $345 (s.d., $64) for the behavioral intervention ($31 per telephone encounter), and $416 (s.d., $93) for the combined intervention. Patient time costs were estimated at $585 (s.d., $487) for home monitoring, $55 (s.d., $16) for the behavioral intervention, and $741 (s.d., $529) for the combined intervention.


CONCLUSIONS
Our analysis demonstrated that the interventions are cost-additive to the health-care system in the short term and that patients' time costs are nontrivial.
Reed
Shelby D
SD
Center for Clinical and Genetic Economics, Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA. shelby.reed@duke.edu
Li
Yanhong
Y
Oddone
Eugene Z
EZ
Neary
Alice M
AM
Orr
Melinda M
MM
Grubber
Janet M
JM
Graham
Felicia L
FL
Olsen
Maren K
MK
Svetkey
Laura P
LP
Dolor
Rowena J
RJ
Powers
Benjamin J
BJ
Adams
Martha B
MB
Bosworth
Hayden B
HB
D000368:Aged; D018660:Blood Pressure Monitoring, Ambulatory / Q000191:economics*; D003365:Costs and Cost Analysis; D004522:Educational Status; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000191:economics* / Q000503:physiopathology / Q000628:therapy*; D008019:Life Style; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012648:Self Care; D013689:Telephone