Research and Clinical Delivery Costs of a Mobile Health Approach for Hypertension Management in Uncontrolled Hypertensive African Americans: A Cost Analysis

OBJECTIVES: The MI-BP app is a mobile health (mHealth) approach that helps African Americans with uncontrolled hypertension (HTN) manage HTN and reduce health disparities. As the cost for a mHealth HTN-management approach has not been examined in marginalized populations, this study estimates its research and clinical implementation cost among African Americans.

METHODS: A 1-year randomized controlled trial (RCT) comparing enhanced usual care (EUC) and EUC + MI-BP was assessed for research and clinical delivery costs from a healthcare perspective. 167 uncontrolled hypertensive African American adults aged 25-70 years from Detroit, Michigan were studied from the baseline. Using a micro-costing approach, the research setting analyzed the 5-year costs including the trial's preparation and research stages, and the clinical setting examined the 1-year patient-related cost within the trial, both considering labor, equipment, and follow-up costs. We calculated the total costs in both settings and the monthly per-patient costs specifically in the clinical setting. Multiple sensitivity analyses were performed to identify key cost determinants and assess the interaction effect of the patient number and retention.

RESULTS: The RCT for studying the effectiveness of MI-BP cost $1,537,192 in total. The average monthly cost per patient in a clinical setting was $139. The primary cost determinant in both settings was labor costs, accounting for 76.24% and 72.68% of the total cost, respectively. In the research setting, modifying the patient volume from 100 to 1,000 increased the total cost by $643,903.69 ($1,489,042.74 - $2,132,946.43), and in the clinical setting, reduced the monthly per-patient cost by $185.14 ($221.46 - $36.31) on average.

CONCLUSIONS: This study contributes evidence to inform better budgets for future related research and clinical practice of mHealth approaches for HTN management by providing cost estimates of the MI-BP app. Patient volume, labor, and app development have the greatest impact on the costs and should be emphasized when implementing relative approaches.