Cost-Effectiveness of Ambulatory Blood Pressure

Abstract

Abstract-Accurate diagnosis of hypertension and prognosis for future cardiovascular events can be enhanced through the use of 24-hour ambulatory blood pressure monitoring. It has been suggested that the use of ambulatory monitoring as a secondary screening for hypertension might be cost-effective. Many needed studies that are related to the calculation of costeffectiveness for ambulatory monitoring have become available in recent years. More accurate estimates for cost of care, costs for testing, prevalence of white-coat hypertension, and incidence of the transition from normal pressures to hypertension have been reported. This study presents calculations of the cost savings likely to take place when ambulatory blood pressure monitoring is implemented for newly detected hypertensive subjects. These calculations are based on current estimates for cost of testing, cost of treatment, prevalence of white-coat hypertension at baseline, and varying the incidence of new hypertension after the initial screening. The results indicate a potential savings of 3% to 14% for cost of care for hypertension and 10% to 23% reduction in treatment days when ambulatory blood pressure monitoring is incorporated into the diagnostic process. At current reimbursement rates, the cost of ambulatory blood pressure monitoring for secondary screening on an annual basis would be Ͻ10% of treatment costs. Calculated savings for use of ambulatory blood pressure monitoring can take place when annual treatment costs are as little as $300. These estimates should be considered for the management of recently detected hypertension, especially when the risk of future cardiovascular is disease is low. Key Words: ambulatory blood pressure monitoring, ambulatory Ⅲ hypertension, white-coat Ⅲ cost benefit analysis P rospective surveys have established the value of ambulatory blood pressure monitoring (ABPM), compared with, or additive to, clinic pressures, for predicting the risk of fatal and nonfatal cardiovascular disease in hypertensive groups. [1][2][3][4][5][6] The use of ABPM for untreated hypertensive patients, initially detected by clinic pressures, to define those with lower daytime and/or 24-hour average pressures has led to the concept of white-coat hypertension (WCH). 7 Pooled results from several prospective observational studies have shown that the likelihood for future stroke in WCH is nearly that of normal subjects for 5-year follow-up intervals. 8 WCH hypertension may also be related to a more favorable overall cardiovascular risk profile reflected by lower body mass index and favorable serum lipid patterns. 9 These findings support recommendations in current guidelines that ABPM be used in the management of hypertension. 10 -12 ABPM is well tolerated by patients in primary care practices who consider the information provided to be helpful for their management. 13 Additional recognition of the value of ABPM has been the approval for reimbursement by the Center for Medicare and Medicaid Services of the United States (CMS).When ABPM became av...

Self blood pressure monitoring: a worthy substitute for ambulatory blood pressure?

“…45 There is also evidence that the use of SBPM can lead to improved compliance with antihypertensive medication 46 and improved BP control. 47,48 Although ABPM has been shown to be costeffective 9,10 in diagnosing hypertension, it is impractical for assessing and managing all patients in primary care. SBPM is cheaper than ABPM with equivalent diagnostic accuracy and has been proposed by some as the way forward for managing hypertension.…”

Call to Action on Use and Reimbursement for Home Blood Pressure Monitoring

“…151,152 If HBPM and ABPM were fully equivalent with regard to detection of white-coat hypertension, then any difference in cost between the 2 methods would be a basis for choosing the one that costs less. Currently, Medicare reimburses ABPM for patients with suspected white-coat hypertension.…”

The OXIMAPA Study: Hypertension Control by ABPM and Association with Sleep Apnea Syndrome by Pulse Oximetry

“…Thus, ABPM has detected more 12% (six cases) of uncontrolled hypertensive patients compared to the office BP, suggesting that ABPM assessment is greater than the office evaluation regarding the diagnostic sensitivity, similar to what has been stated in several studies. [18][19][20] ABPM also provides valuable data for the CVR approach, such as blood pressure load 40 and pulse pressure, 41 and, also with some growing evidence, the variability of blood pressure 42 and the morning surge, 43 however this was not assessed in our study.…”

“…[11][12][13][14][15][16][17] There are several available techniques for the hypertension diagnosis and control, including the evaluation in medical office, ambulatory self-measurement and ambulatory blood pressure monitoring by automatic device (ABPM). Several studies and international guidelines refer to the ABPM as an essential tool in the evaluation and control of hypertension, and therefore it is a good indicator of cardiovascular risk, exhibiting the best efficacy and costeffectiveness, [18][19][20] including in the Portuguese population.…”