Prerequisites for Cost-Effective Home Blood Pressure Telemonitoring: Early Health Economic Analysis.

Abstract

Background: Home blood pressure telemonitoring (HBPT) has been proposed to enhance adherence and optimize health care delivery, yet its prerequisites for cost-effective implementation remain unclear.

Objective: This study aims to quantify the potential cost-effectiveness of HBPT and identify prerequisites for cost-effective implementation of HBPT in comparison to standard hypertension management, using an early health economic analysis from a societal perspective.

Methods: A decision-analytic Markov model with a lifetime horizon (30 years) and a willingness-to-pay threshold of €20,000 (€1=US $1.09) per quality-adjusted life year (QALY) was developed to assess the cost-effectiveness of HBPT compared to standard of care (SOC). The HBPT intervention was based on an existing HBPT program applied by the Maasstad Hospital, Rotterdam, the Netherlands. The model incorporated 12 health states: 7 blood pressure states, 1 cardiovascular (CV) event, 1 recurrent CV event, 1 postrecurrent CV event, 1 all-cause death, and 1 CV disease-related death. A hypothetical cohort of 1000 patients (average age 65.3 years) was modeled, and results were reported in costs, QALYs, and the incremental cost-effectiveness ratio (ICER). The model assumed 3 in-person outpatient department (OPD) consultations in the SOC group and 1.5 in the HBPT group. Extensive sensitivity analyses were performed to identify important variables for the cost-effective implementation of HBPT.

Results: Following the base-case analysis, HBPT was not cost-effective with an ICER of €20,386 per QALY. Sensitivity analyses indicated that reducing the number of in-person OPD consultations resulted in a more favorable ICER. Specifically, reducing the number of in-person OPD consultations to 1.48 annually resulted in an ICER below the willingness-to-pay threshold. Reducing the in-person OPD consultations to an average of 1.18 per year would make HBPT cost-saving. Scenario analyses revealed that extending the duration of HBPT's clinical effect to 2 or 3 years substantially improved the ICER. Additionally, targeting HBPT toward patients aged 64 years or below further improved the ICER.

Conclusions: HBPT could result in cost-effective or cost-saving outcomes with only minor reductions in in-person OPD consultations. These findings highlight the potential of HBPT to transform hypertension management by replacing traditional hypertension management with more efficient care using remote patient monitoring.