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Economic evaluation of the home blood pressure telemonitoring and pharmacist case management to control hypertension (Hyperlink) trial
Author(s) -
Dehmer Steven P.,
Maciosek Michael V.,
Trower Nicole K.,
Asche Stephen E.,
Bergdall Anna R.,
Nyboer Rachel A.,
O'Connor Patrick J.,
Pawloski Pamala A.,
SperlHillen JoAnn M.,
Green Beverly B.,
Margolis Karen L.
Publication year - 2018
Publication title -
journal of the american college of clinical pharmacy
Language(s) - English
Resource type - Journals
ISSN - 2574-9870
DOI - 10.1002/jac5.1001
Subject(s) - medicine , blood pressure , pharmacy , pharmacist , hyperlink , psychological intervention , randomized controlled trial , emergency medicine , health care , physical therapy , family medicine , nursing , web page , world wide web , computer science , economics , economic growth
Background Pharmacist‐managed (team‐based) care for hypertension with home blood pressure monitoring support interventions has been widely studied and shown to be effective in improving rates of hypertension control and lowering blood pressure; however, few studies have evaluated the economic considerations related to bringing these programs into usual practice. Objective To analyze the economic outcomes of the Home Blood Pressure Telemonitoring and Case Management to Control Hypertension (Hyperlink) study, a cluster randomized controlled trial which used home blood pressure telemonitoring and pharmacist case management to achieve better blood pressure control in patients with uncontrolled hypertension was conducted. Methods A prospective analysis compared differences in medical costs and encounters in the Hyperlink telemonitoring intervention and usual care groups in the 12 months pre‐ and postenrollment using medical and pharmacy insurance claims from a health care sector perspective. Generalized estimating equation models were used to estimate differences between the groups over time. These results, combined with previously published prospective study results on intervention costs and blood pressure outcomes, were used to estimate cost‐effectiveness measures for blood pressure control and reduction. Findings Total medical costs in the intervention group were lower compared with the usual care group by an average of $281 per person, but this difference was not statistically significant. Clinic‐based office visit, radiology, pharmacy and hospital costs were also nonsignificantly lower in the intervention group. Statistically significant differences were found in lipid‐related laboratory costs (higher) and in hypertension‐related (higher) and lipid‐related (lower) pharmacy costs. Patterns in medical costs were similar for medical encounters. On average, the intervention cost $7337 per person achieving hypertension control and $139 or $265 per mm Hg reduction in systolic or diastolic blood pressure, respectively. Conclusions Home blood pressure monitoring and pharmacist case management to improve hypertension care can be implemented without increasing, and potentially reducing, overall medical care costs.