Prerequisites for Cost-Effective Home Blood Pressure Telemonitoring: Insights From an Early Health Economic Analysis

OBJECTIVES: Home Blood Pressure Telemonitoring (HBPT) has the potential to enhance adherence and optimize healthcare delivery. However, until now the health and economic impact is unclear. Therefore, this study aims to quantify the cost-effectiveness of HBPT compared to standard hypertension management, using an early health economic analysis.

METHODS: A Markov model with a lifetime horizon (30 years) was developed to assess the cost-effectiveness of HBPT compared to standard of care (SOC) with a willingness-to-pay (WTP) threshold of €20,000 per quality-adjusted life year (QALY). The HBPT intervention was based on the HBPT program developed by the Maasstad Hospital, Rotterdam, the Netherlands. The model incorporated 12 health states including 7 blood pressure states, cardiovascular event, recurrent event, post recurrent event, all-cause death, and cardiovascular death. A hypothetical cohort of 1,000 patients was modelled and results were reported in costs, QALYs and the incremental cost-effectiveness ratio (ICER). Extensive sensitivity analyses were performed to assess the impact of parameter uncertainty and varying scenarios on the ICER.

RESULTS: Following the base-case analysis, HBPT resulted in an ICER of €32,502 per QALY. Sensitivity analyses indicated that reducing the number of outpatient department (OPD) consultations result in a more favorable ICER. Specifically, reducing the number of OPD consultations from 1.5 to 1.3 annually resulted in an ICER below the WTP threshold. A reduction to an average of 0.95 consultations per year would lead to cost-savings following HBPT. Scenario analyses revealed that extending the duration of HBPT's clinical effect to two or three years substantially improved the ICER. Additionally, targeting patients aged 41 or below with HBPT further improved the ICER.

CONCLUSIONS: HBPT could result in cost-effective or even cost-saving outcomes with only minor reductions in 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.