Abstract 23: Cost-Benefit Analysis of Home Blood Pressure Monitoring: A Business Case
BACKGROUND: Home blood pressure monitoring (HBPM) is more effective than clinic monitoring (CBPM) for both diagnosing and managing hypertension. However, reimbursement of home blood pressure monitors is uncommon in the United States due to a lack of evidence that HBPM is cost-beneficial from an insurance perspective.
METHODS: We analyzed claims data from a large U.S. health insurer, which included both a commercial plan as well as a Medicare Advantage plan. We used a decision analytic model to depict transitions among various states from initial physician visit, to hypertension diagnosis, to treatment, to hypertension-related cardiovascular disease states, and beneficiary deaths or resignations from the plan. Model inputs were derived from the insurer’s 2008-2011 claims data, the 2009-2010 National Health and the Nutrition Examination Survey (NHANES), and from published literature. We estimated both short- and long-run (10-year) cost-benefit and return on investment (ROI) (net-savings relative to cost) of HBPM compared to CBPM for different age groups. We conducted a sensitivity analysis to estimate financial risk to the insurer under various implementation scenarios.
RESULTS: Overall net savings per member were $33.80 (ROI = 0.94) in the first year and $414.80 (ROI = 8.37) after 10 years for the age group 20-44, $32.70 (ROI = 0.84) in the first year and $439.10 (ROI = 7.50) after 10 years for those age 45-64, and $166.20 (ROI = 3.75) in the first year and $1,364.3 (ROI = 19.34) after 10 years for Medicare beneficiaries age > 65. For non-elderly adults most of the savings were related to the superior diagnostic specificity of HBPM. Conversely, for Medicare beneficiaries most of the savings were related to better blood pressure control when HBPM was used to monitor hypertension treatment following diagnosis. For example, in those age 20-44 the ROI was positive in both the short run (1 year = 0.87) and long run (10 year = 11.26) when HBPM was used to diagnose hypertension, but negative when it was used to monitor hypertension treatment (1 year = -0.87; 10 year = -0.33). On the other hand, when HBPM was used to diagnose hypertension in elderly adults (age > 65), the ROI was initially negative (1 year = -0.36) but then became positive (3 year = 0.81; 10 year = 3.75), and when used to monitor treatment the ROI was positive throughout (1 year = 4.37; 10 year = 18.54).
CONCLUSIONS: Our analysis shows for the first time that paying for HBPM is cost-beneficial for insurers. We also show that ROIs can be optimized, while minimizing financial risk, by focusing on specific uses of HBPM for different age groups. Our study suggests that optimal ROIs may be achieved if HBPM is used for hypertension diagnosis in non-elderly adults (age < 65) and for both diagnosis and management in the elderly (age > 65).
Author Disclosures: A. Arrieta: None. J. Woods: None. S. Jay: None. N. Qiao: None.
- © 2014 by American Heart Association, Inc.