Abstract
BackgroundElevated blood pressure is a major risk factor for cardiovascular disease and stroke but patients often discount recommended behavioral changes and prescribed medications. While effective interventions to promote adherence have been developed, cost-effectiveness from the patient’s perspective, has not been well studied. The valuation of patient time and out of pocket expenses should be included while performing cost effectiveness evaluation. The AchieveBP study uses the contingent valuation method to assess willingness to accept (WTA) and willingness to pay (WTP) among patients with a history of uncontrolled blood pressure discharged from an urban emergency department and enrolled in a larger randomized controlled trial.MethodsWTA and WTP were assessed by asking patients a series of questions about time and travel costs and time value related to their study participation. A survey was conducted during the final study visit with patients to investigate the effectiveness of a kiosk-based educational intervention on blood pressure control. All study patients, regardless of study arm, received the same clinical protocol of commonly prescribed antihypertensive medication and met with research clinicians four times as part of the study procedures.ResultsThirty-eight patients were offered the opportunity to participate in the cost-effectiveness study and all completed the survey. Statistical comparisons revealed these 38 patients were similar in representation to the entire RCT study population. All 38 (100.0%) were African-American, with an average age of 49.1 years; 55.3% were male, 21.1% were married, 78.9% had a high school or higher education, and 44.7% were working. 55.9% did not have a primary care provider and 50.0% did not have health insurance. Time price linear regression analysis was performed to estimate predictors of WTA and WTP.ConclusionsWTP and WTA may generate different results, and the elasticities were proportional to the estimated coefficients, with WTP about twice as responsive as WTA. An additional feature for health services research was successful piloting in a clinical setting of a brief patient-centered cost effectiveness survey.Trial registrationhttps://clinicaltrials.gov. Registration Number NCT02069015. Registered February 19, 2014 (Retrospectively registered).
Highlights
Elevated blood pressure is a major risk factor for cardiovascular disease and stroke but patients often discount recommended behavioral changes and prescribed medications
The present study demonstrates the use of both willingness to pay (WTP) and willingness to accept (WTA) as part of a cost-effectiveness evaluation of an educational intervention, Achieving Blood Pressure Control through Enhanced Discharge (AchieveBP)
Data for this study were collected within AchieveBP, a larger randomized clinical trial (RCT) which integrated an interactive kiosk with an evidence- based curriculum into the clinical discharge process of an urban emergency department
Summary
Patient enrollment and data collection The population for the cost-effectiveness study constituted a subgroup of AchieveBP patients who completed the six-month follow-up. Regardless of study arm, received the same antihypertensive protocol, including commonly prescribed medication, assuring standard clinical practice for treatment of blood pressure [13]. Thirty-eight (56.7%) of the 67 patients who completed the AchieveBP study protocol had their last visit during the time of the cost-effectiveness study. The survey encompassed 14 items asking about travel distance and time to and from the study site, mode of transportation, travel costs, time spent per study visit and four items specific to WTP and WTA. Data collection for the cost effectiveness study was conducted during the final study visit, at the University Clinical Research Center, within walking distance from the hospital emergency department. Elasticity coefficients were calculated using the formulation (Additional file 2) to relate percentage changes in WTP or WTA to percentage changes in time spent or saved and to evaluate whether increase or decrease in prices would generate different outcomes
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
