title: Economic analysis of a tailored behavioral intervention to improve blood pressure control for primary care patients.
abstract: BACKGROUND
  Few telemedicine programs have undergone cost analyses, impeding their implementation into practice. We report on the economic analysis of a nurse-administered intervention designed to improve blood pressure control among hypertensive veterans.
  
  
  METHODS
  We randomized hypertensive patients at the Durham Veterans Affairs Medical Center primary care clinic to behavioral (n = 294) or nonbehavioral (n = 294) interventions. Behavioral intervention patients received tailored information bimonthly for 2 years via telephone. To calculate intervention cost, we microcosted the nurse's labor cost and computer hardware and software costs, applied a direct-to-indirect cost ratio, and distributed the costs over an estimated cohort of patients. We analyzed data from the Veterans Affairs Decision Support System to assess whether the intervention impacted overall health care utilization and costs. We used life expectancy estimates from the literature to develop decision models to calculate cost per life-year saved.
  
  
  RESULTS
  The mean annual intervention cost was $112 (range $61-$259). During 2 years of follow-up, patients in the intervention group incurred $7,800 in inpatient costs and $9,741 in outpatient costs; the nonintervention group incurred $6,866 in inpatient costs and $9,599 in outpatient costs. The total cost difference was not statistically significant (P = .56). Cost-effectiveness of the behavioral intervention ranged from $42,457 per life-year saved for normal-weight women to $87,300 per life-year saved for normal-weight men.
  
  
  CONCLUSIONS
  The study results suggest that a nurse-administered, tailored behavioral intervention can be implemented at nominal cost and be cost-effective; however, there was no apparent lowering of health care utilization and costs during the 2 years of follow-up.
authors.affiliation: Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC 27705, USA. santanu.datta@duke.edu
authors.forename: Santanu K
authors.initials: SK
authors.lastname: Datta
authors.forename: Eugene Z
authors.initials: EZ
authors.lastname: Oddone
authors.forename: Maren K
authors.initials: MK
authors.lastname: Olsen
authors.forename: Melinda
authors.initials: M
authors.lastname: Orr
authors.forename: Felicia
authors.initials: F
authors.lastname: McCant
authors.forename: Pam
authors.initials: P
authors.lastname: Gentry
authors.forename: Hayden B
authors.initials: HB
authors.lastname: Bosworth
mesh_terms: D000368:Aged; D001521:Behavior Therapy / Q000191:economics*; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D006296:Health Services / Q000706:statistics & numerical data; D006760:Hospitalization / Q000191:economics; D006787:Hospitals, Veterans / Q000191:economics; D006801:Humans; D006973:Hypertension / Q000191:economics / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D009657:North Carolina; D009741:Nursing Staff, Hospital / Q000191:economics; D011320:Primary Health Care / Q000191:economics*; D017216:Telemedicine / Q000191:economics* / Q000379:methods; D013689:Telephone; D014728:Veterans