Economic evaluation of home blood pressure monitoring with or without telephonic behavioral self-management in patients with hypertension.

摘要

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