Abstract 072: Return on Investment of Self-Measured Blood Pressure: An Economic Model from the Insurers’ Perspective

Abstract

Introduction: About half of the 70 million adults with hypertension in the U.S. do not have their blood pressure (BP) controlled. An effective strategy to diagnose hypertension and improve BP control is to use self-measured blood pressure (SMBP) devices. Despite evidence supporting the clinical effectiveness of SMBP, most insurers remain unconvinced that the cost of the devices would yield a positive financial return. Objective: We adopted the perspective of private insurers to estimate return-on-investment (ROI) and net present value (NPV) of SMBP devices used to diagnose hypertension (including treatment selection and medication titration) and to manage BP. Methods: We developed a decision-analytic model using Framingham risk predictions and reported SMBP and clinic blood pressure measurement (CBPM) sensitivity and specificity values to simulate health outcomes and their associated annual and lifetime projections of costs and savings for the U.S. population. Results: Compared to CBPM, SMBP benefits exceed investment, producing large positive ROIs and NPVs. SMBP is cost-beneficial in the short-run and at lifetime horizon, but the return declines with patient age (see table). Conclusions: A strong business case exists for reimbursing SMBP, but only when it is used both to diagnose and to manage hypertension. Its primary economic value stems from its diagnostic role in ruling out white coat hypertension. If SMBP is used solely to manage (but not to diagnose) hypertension, our model indicates that its incremental effects on blood pressure reduction and cardiovascular event rates are not large enough to produce positive financial gains.