title: Cost-benefit analysis of home blood pressure monitoring in hypertension diagnosis and treatment: an insurer perspective.
abstract: Home blood pressure (BP) monitoring has been shown to be more effective than clinic BP monitoring for diagnosing and treating hypertension. However, reimbursement of home BP monitoring is uncommon in the United States because of a lack of evidence that it is cost beneficial for insurers. We develop a decision-analytic model, which we use to conduct a cost-benefit analysis from the perspective of the insurer. Model inputs are derived from the 2008 to 2011 claims data of a private health insurer in the United States, from 2009 to 2010 National Health and the Nutrition Examination Survey data, and from published meta-analyses. The model simulates the transitions among health states from initial physician visit to hypertension diagnosis, to treatment, to hypertension-related cardiovascular diseases, and patient death or resignation from the plan. We use the model to estimate cost-benefit ratios and both short- and long-run return on investment for home BP monitoring compared with clinic BP monitoring. Our results suggest that reimbursement of home BP monitoring is cost beneficial from an insurer's perspective for diagnosing and treating hypertension. Depending on the insurance plan and age group categories considered, estimated net savings associated with the use of home BP monitoring range from $33 to $166 per member in the first year and from $415 to $1364 in the long run (10 years). Return on investment ranges from $0.85 to $3.75 per dollar invested in the first year and from $7.50 to $19.34 per dollar invested in the long run.
authors.affiliation: From the Department of Health Policy and Management, Florida International University, Miami (A.A.); Indiana University Health Methodist Research Institute (J.R.W.), Indiana University School of Medicine (S.J.J.), and Indiana University Richard M. Fairbanks School of Public Health (J.R.W., S.J.J.), Indianapolis; and Department of Economics, Indiana University-Purdue University Indianapolis (N.Q.). alejarri@fiu.edu.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Arrieta
authors.affiliation: From the Department of Health Policy and Management, Florida International University, Miami (A.A.); Indiana University Health Methodist Research Institute (J.R.W.), Indiana University School of Medicine (S.J.J.), and Indiana University Richard M. Fairbanks School of Public Health (J.R.W., S.J.J.), Indianapolis; and Department of Economics, Indiana University-Purdue University Indianapolis (N.Q.).
authors.forename: John R
authors.initials: JR
authors.lastname: Woods
authors.affiliation: From the Department of Health Policy and Management, Florida International University, Miami (A.A.); Indiana University Health Methodist Research Institute (J.R.W.), Indiana University School of Medicine (S.J.J.), and Indiana University Richard M. Fairbanks School of Public Health (J.R.W., S.J.J.), Indianapolis; and Department of Economics, Indiana University-Purdue University Indianapolis (N.Q.).
authors.forename: Nan
authors.initials: N
authors.lastname: Qiao
authors.affiliation: From the Department of Health Policy and Management, Florida International University, Miami (A.A.); Indiana University Health Methodist Research Institute (J.R.W.), Indiana University School of Medicine (S.J.J.), and Indiana University Richard M. Fairbanks School of Public Health (J.R.W., S.J.J.), Indianapolis; and Department of Economics, Indiana University-Purdue University Indianapolis (N.Q.).
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Jay
mesh_terms: D000328:Adult; D000368:Aged; D018660:Blood Pressure Monitoring, Ambulatory / Q000191:economics* / Q000379:methods; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy*; D007343:Insurance Carriers / Q000191:economics*; D007349:Insurance, Health, Reimbursement / Q000191:economics; D008297:Male; D008875:Middle Aged; D018803:Models, Economic; D014481:United States; D055815:Young Adult
keywords: blood pressure monitoring, ambulatory; hypertension; masked hypertension; reimbursement; white coat hypertension