Effects of technology-enabled blood pressure monitoring in primary care: A quasi-experimental trial

Teo, Valerie; Teo, Sok Huang; Burkill, Sarah; Wang, Yi; Chew, Evelyn Al; Ng, David Wl; Tang, Wern Ee; Koh, Gerald

doi:10.1177/1357633x211031780

Cited by 17 publications

(44 citation statements)

References 17 publications

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“…6,[13][14][15][16]20,21,[23][24][25][26][27][28][29][30][31] An incremental analysis of costs and outcomes was conducted in 15 studies (94%). 6,[13][14][15]20,21,[23][24][25][26][27][28][29][30][31] A sensitivity analysis was conducted in 15 studies (94%). 6,[13][14][15][16]20,21,[23][24][25][26][27][28][29][30] The majority of the studies provided a comprehensive assessment of the costeffectiveness of the intervention over the control.…”

Section: Study Quality Assessment Criteriamentioning

confidence: 99%

“…6,[13][14][15][16]20,21,[23][24][25][26][27][28][29][30] All of the studies adequately described the study setting and discussed the issue of generalizing the results to a different setting with similar characteristics. 6,[13][14][15][16]20,21,[23][24][25][26][27][28][29][30][31]…”

Section: Study Quality Assessment Criteriamentioning

confidence: 99%

“…The definition of usual care had minor differences but was generally considered as patients monitored per usual clinical care from their clinician without self-BP monitoring. 31 All articles included an intervention in which patients self-measured their BP at home using an electronic device and transferred their BP results to clinicians at a different location (ie, HBPM). HBPM was classified into 3 categories 37 : HBPM alone, HBPM with additional support (eg, basic website, online patient portals, or telephone consultations with clinicians or nurses 17 ), and HBPM within team-based care (TBC), which involved more labor-intensive efforts, often combined with other behavioral interventions, such as pharmacist care [17][18][19] or nurse behavioral interventions.…”

Section: Jama Network Open | Health Informaticsmentioning

confidence: 99%

“…Among the 16 studies, 7 utilized CEA, 6,14,16,20,21,25,29 6 used CUA, 13,23,[26][27][28]30 and 3 utilized both CUA and CEA. 15,24,31 A societal perspective was only reported in 2 studies, 16,31 and the rest were conducted using a health care system perspective. 6,[13][14][15]20,21,[23][24][25][26][27][28][29][30] The types of costs reported in each article were different, with 3 studies reporting direct medical costs only, 14,28,31 1 reporting only program costs, 20 and 12 reporting both 6,13,15,16,21,[23][24][25][26][27]29,30 (Table 2).…”

Section: Economic Analysismentioning

confidence: 99%

“…Of the 16 identified studies, 9 reported that an at-home BP monitoring intervention (HBPM or ABPM) had an ICER within the WTP thresholds, indicating the intervention as cost-effective compared with clinical UC. 13,15,23,24,[26][27][28]30,31 Of the remaining 7, all were studies with time periods ranging from 6 to 24 months. 6,14,16,20,21,25,29 Of the 12 identified studies that compared the cost-effectiveness of HBPM vs UC, 5 (42%) reported the intervention as being cost-effective.…”

Section: Cost-effective Interventionsmentioning

confidence: 99%

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Economic Evaluation of Blood Pressure Monitoring Techniques in Patients With Hypertension

Hayek,

Giannouchos,

Lawley

et al. 2023

JAMA Netw Open

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ImportanceBlood 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.ObjectiveTo identify and synthesize published research examining the cost-effectiveness of at-home blood pressure self-monitoring relative to monitoring in a clinical setting among patients with hypertension.Evidence ReviewA systematic literature search of 5 databases (PubMed, MEDLINE, Embase, EconLit, and CINAHL) followed by a backward citation search was conducted in September 2022. Full-text, peer-reviewed articles in English including patients with high blood pressure (systolic blood pressure ≥130 mm Hg and diastolic blood pressure ≥80 mm Hg) at baseline were included. Data from studies comparing at-home self-monitoring with clinical-setting monitoring alternatives were extracted, and the outcomes of interest included incremental cost-effectiveness and cost-utility ratios. Non–peer-reviewed studies or studies with pregnant women and children were excluded. To ensure accuracy and reliability, 2 authors independently evaluated all articles for eligibility and extracted relevant data from the selected articles.FindingsOf 1607 articles identified from 5 databases, 16 studies met the inclusion criteria. Most studies were conducted in the US (6 [40%]) and in the UK (6 [40%]), and almost all studies (14 [90%]) used a health care insurance system perspective to determine costs. Nearly half the studies used quality-adjusted life-years gained and cost per 1–mm Hg reduction in blood pressure as outcomes. Overall, at-home blood pressure monitoring (HBPM) was found to be more cost-effective than monitoring in a clinical setting, particularly over a minimum 10-year time horizon. Among studies comparing HBPM alone vs 24-hour ambulatory blood pressure monitoring (ABPM) or HBPM combined with additional support or team-based care, the latter were found to be more cost-effective.Conclusions and RelevanceIn 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.

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