Economics of Self-Measured Blood Pressure Monitoring: A Community Guide Systematic Review

• Type of Material: Article
• Authors: Verughese Jacob, Centers for Disease Control and Prevention; Sajal K. Chattopadhyay, Centers for Disease Control and Prevention; Krista K. Proia, Centers for Disease Control and Prevention; David P. Hopkins, Centers for Disease Control and Prevention; Jeffrey Reynolds, Centers for Disease Control and Prevention; Anilkrishna B. Thota, Centers for Disease Control and Prevention; Christopher D. Jones, Centers for Disease Control and Prevention; Daniel T. Lackland, Medical University of South Carolina; Kimberly J Rask, Emory University; Nicolaas P. Pronk, HealthPartners Institute; John M. Clymer, National Forum for Heart Disease and Stroke Prevention; Ron Z. Goetzel, Johns Hopkins University
• Language: English
• Date: 2017-09-01
• Publisher: Elsevier: 12 months
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2018 Elsevier Inc.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.amepre.2017.03.002
• Title of Journal or Parent Work: American Journal of Preventive Medicine
• ISSN: 0749-3797
• Volume: 53
• Issue: 3
• Start Page: E105
• End Page: E113
• Grant/Funding Information: The work of Jeffrey Reynolds was supported with funds from the Oak Ridge Institute for Science and Education.
• Keywords: Public, Environmental & Occupational Health; General & Internal Medicine; AFRICAN-AMERICANS; TELEMEDICINE CASE-MANAGEMENT; STROKE ASSOCIATION; HYPERTENSION CONTROL; TASK-FORCE RECOMMENDATION; Science & Technology; Medicine, General & Internal; USUAL CARE; COST-EFFECTIVENESS EVALUATION; AMERICAN-HEART-ASSOCIATION; DIABETES-MELLITUS; RANDOMIZED-CONTROLLED-TRIAL; Life Sciences & Biomedicine
• Research Categories: Health Sciences, General; Health Sciences, Public Health

Abstract

Context The health and economic burden of hypertension, a major risk factor for cardiovascular disease, is substantial. This systematic review evaluated the economic evidence of self-measured blood pressure (SMBP) monitoring interventions to control hypertension. Evidence acquisition The literature search from database inception to March 2015 identified 22 studies for inclusion with three types of interventions: SMBP used alone, SMBP with additional support, and SMBP within team-based care (TBC). Two formulae were used to convert reductions in systolic BP (SBP) to quality-adjusted life years (QALYs) to produce cost per QALY saved. All analyses were conducted in 2015, with estimates adjusted to 2014 U.S. dollars. Evidence synthesis Median costs of intervention were $60 and $174 per person for SMBP alone and SMBP with additional support, respectively, and $732 per person per year for SMBP within TBC. SMBP alone and SMBP with additional support reduced healthcare cost per person per year from outpatient visits and medication (medians $148 and $3, respectively; median follow-up, 12–13 months). SMBP within TBC exhibited an increase in healthcare cost (median, $369 per person per year; median follow-up, 18 months). SMBP alone varied from cost saving to a maximum cost of $144,000 per QALY saved, with two studies reporting an increase in SBP. The two translated median costs per QALY saved were $2,800 and $4,000 for SMBP with additional support and $7,500 and $10,800 for SMBP within TBC. Conclusions SMBP monitoring interventions with additional support or within TBC are cost effective. Cost effectiveness of SMBP used alone could not be determined.