In a recent article published in JAMA Network Open, scientists conducted a systematic literature review to identify published research investigating the cost-effectiveness of at-home blood pressure self-monitoring relative to monitoring in a clinical setting among patients with hypertension.
The authors wrote, “Blood pressure monitoring is critical to the timely diagnosis and treatment of hypertension. At-home self-monitoring techniques are highly effective in managing high blood pressure; however, evidence regarding the cost-effectiveness of at-home self-monitoring compared with traditional monitoring in clinical settings remains unclear.”
The review included full-text, peer-reviewed articles in English, including patients with high blood pressure (systolic blood pressure ≥130 mmHg and diastolic blood pressure ≥80 mmHg) at baseline. Data from studies comparing at-home self-monitoring with clinical-setting monitoring alternatives were extracted, and the outcomes of interest comprised incremental cost-effectiveness and cost-utility ratios. Non–peer-reviewed studies or studies with pregnant women and children were excluded. Two authors independently assessed all articles for eligibility and extracted relevant data from the selected article to ensure accuracy and reliability.
Using five databases, researchers identified 1,607 articles and 16 studies that met the inclusion criteria. The majority of the studies were conducted in the United States (6 [40%]) and in the United Kingdom (6 [40%]), and almost all studies (14 [90%]) used a healthcare insurance system perspective to ascertain costs.
Results revealed that nearly half of the studies used quality-adjusted life-years gained and cost per 1-mmHg reduction in blood pressure as outcomes, and overall, at-home blood pressure monitoring (HBPM) was revealed to be more cost-effective than monitoring in a clinical setting, predominantly over a minimum 10-year time horizon. Amid studies comparing HBPM alone versus 24-hour ambulatory blood pressure monitoring (ABPM) or HBPM combined with supplementary support or team-based care (TBC), the latter was revealed to be more cost-effective.
The authors indicated that among the studies, they identified an estimated 60% verified at-home self-monitoring (BPM or ABPM) to be cost-effective over typical care, particularly long-term.
The authors also noted, “HBPM was also found to be cost-effective when combined with additional support or within TBC compared with HBPM alone. For studies comparing HBPM alone with UC [usual care] and with ABPM, ABPM was found to be the most cost-effective method.”
Based on their findings, the authors concluded, “In this systematic review, at-home blood pressure self-monitoring, particularly using automatic 24-hour continuous blood pressure measurements or combined with additional support or team-based care, demonstrated the potential to be cost-effective long-term compared with care in the physical clinical setting and could thus be prioritized for patients with hypertension from a cost-effectiveness standpoint.”
The authors also noted that their findings imply that clinicians, hospitals, healthcare systems, third-party payers, and other stakeholders should prioritize HBPM as the foremost strategy for blood pressure measurement among patients with hypertension.
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