BLOOD PRESSURE TELEMONITORING AND REMOTE COUNSELING IN PATIENTS WITH UNCONTROLLED HYPERTENSION: A COST-UTILITY ANALYSIS

Abstract

Objective: Telehealth is a useful adjunct in hypertension (HTN) management. Despite obvious short-term clinical benefit, long-term social impact and cost-effectiveness have not been fully investigated. The aim of the study was to perform predictive modeling of long-term clinical and social outcomes and to conduct a cost-utility analysis of blood pressure (BP) telemonitoring and remote counseling (BPTM) in patients with HTN. Design and method: A Markov cohort-based (n = 2000 patients) model was developed and adopted a 10-year time horizon with 12-month time cycles. Cost and outcome data collected from the three-month study of 240 patients (160 in BPTM group and 80 controls, 48 y.o.). All patients started at non-complicated HTN state then moving to disease complications with a certain transition probabilities over a discrete time period (1 Markov cycle). BPTM was compared with usual care in terms of lifetime costs, quality adjusted life years using a Ministry of Health of Russian Federation perspective. Results: At the end of a clinical part of the study there was a decrease in office systolic BP by -16,8 ± 2,9 mm Hg -7,9 ± 3,9 mm Hg in BPTM and usual care groups respectively. By the way, there was an improvement in health-related quality of life (measured with MOS SF-36) +16% and +4% in respective groups. In the long-term run when compared with usual care BPTM was more effective in terms mortality (67 versus 91 patients lost and 9,6 versus 9,71 life years gained) and costs (cost of illness 102 508 000 RUR versus 145 237 700 RUR). Taking quality of life measures into account, the effect of BPTM was also more pronounced (8,31 versus 7,82 QALYs). The resultant incremental cost-utility ratio for BPTM was 275 178,98 RUR/1 QALY gained/1 patient (134837,70 RUR/0,49 QALY/1 patient). Conclusions: According to the results of predictive modeling BPTM in clinical practice is likely to lead to reduced cardiovascular morbidity and mortality being also a cost-effective use of healthcare resources. Larger randomized clinical trials will give more information on BPTM cost-effectiveness in other middle-income countries.