Open AccessCost‐effectiveness of home blood pressure telemonitoring and case management in the secondary prevention of cerebrovascular disease in Canada
Author(s) -
Padwal Raj S.,
So Helen,
Wood Peter W.,
Mcalister Finlay A.,
Siddiqui Muzaffar,
Norris Colleen M.,
Jeerakathil Tom,
Stone James,
Valaire Shelley,
Mann Balraj,
Boulanger Pierre,
Klarenbach Scott W.
Publication year - 2019
Publication title -
the journal of clinical hypertension
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.909
H-Index - 67
eISSN - 1751-7176
pISSN - 1524-6175
DOI - 10.1111/jch.13459
Subject(s) - medicine , disease management , cost effectiveness , cost–benefit analysis , pharmacist , blood pressure , quality of life (healthcare) , health care , intervention (counseling) , emergency medicine , quality adjusted life year , disease , intensive care medicine , family medicine , pharmacy , nursing , risk analysis (engineering) , ecology , parkinson's disease , economics , biology , economic growth
Home blood pressure ( BP ) telemonitoring and pharmacist case management reduce BP , but cost‐effectiveness assessments are mixed. We examined the incremental cost‐effectiveness of this intervention vs usual care in Canadians with cerebrovascular disease. A Markov decision model cost‐utility analysis examining community‐residing, high‐risk patients with a recent nondisabling cerebrovascular event was created. A lifetime time horizon and health care payer perspective were used. Achieved BP , future cardiovascular risks, and attendant consequences on quality‐adjusted life years and Canadian dollar costs were modeled. BP telemonitoring was assumed to occur for 3 months, then quarterly. Life tables were used to determine overall mortality, adjusted by cardiovascular disease mortality. Relative efficacies of intervention‐associated BP lowering, resource use, and costs were obtained from Canadian published literature. Reduction in systolic BP of 9.7 mmHg was used in the base case; subsequently, robust sensitivity analyses were conducted. The results showed that, over the lifetime horizon, telemonitoring with case management led to net health care savings of $1929 Canadian and increased per‐patient QALY s by 0.83. These findings were robust to sensitivity analysis, with the intervention remaining dominant or highly cost‐effective. Increasing telemonitoring costs by 50% still resulted in the intervention being dominant; if the costs of telemonitoring plus case management were 2‐3 times base case cost, incremental cost‐effectiveness was $1200‐$4700 per quality‐adjusted life year gained. In conclusion, home BP telemonitoring and pharmacist case management poststroke lowered costs and improved QALY s. Strategies and funding for broad implementation of this dominant strategy should be implemented.