Cost‐effectiveness of home blood pressure telemonitoring and case management in the secondary prevention of cerebrovascular disease in Canada
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 e...
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Published in | The journal of clinical hypertension (Greenwich, Conn.) Vol. 21; no. 2; pp. 159 - 168 |
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Main Authors | , , , , , , , , , , , |
Format | Journal Article |
Language | English |
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United States
John Wiley and Sons Inc
01.02.2019
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Abstract | 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 QALYs 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 QALYs. Strategies and funding for broad implementation of this dominant strategy should be implemented. |
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AbstractList | 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. 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 QALYs 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 QALYs. Strategies and funding for broad implementation of this dominant strategy should be implemented. |
Author | Mcalister, Finlay A. Valaire, Shelley Stone, James Mann, Balraj Klarenbach, Scott W. Norris, Colleen M. Jeerakathil, Tom Padwal, Raj S. Boulanger, Pierre Siddiqui, Muzaffar So, Helen Wood, Peter W. |
AuthorAffiliation | 2 Mazankowski Heart Institute Edmonton Alberta Canada 3 Alberta Health Services Cardiovascular Health and Stroke Strategic Clinical Network Edmonton Alberta Canada 1 Department of Medicine University of Alberta Edmonton Alberta Canada 5 Department of Computing Science University of Alberta Edmonton Alberta Canada 4 Faculty of Nursing University of Alberta Edmonton Alberta Canada |
AuthorAffiliation_xml | – name: 1 Department of Medicine University of Alberta Edmonton Alberta Canada – name: 3 Alberta Health Services Cardiovascular Health and Stroke Strategic Clinical Network Edmonton Alberta Canada – name: 5 Department of Computing Science University of Alberta Edmonton Alberta Canada – name: 2 Mazankowski Heart Institute Edmonton Alberta Canada – name: 4 Faculty of Nursing University of Alberta Edmonton Alberta Canada |
Author_xml | – sequence: 1 givenname: Raj S. orcidid: 0000-0003-3541-2817 surname: Padwal fullname: Padwal, Raj S. email: rpadwal@ualberta.ca organization: Mazankowski Heart Institute – sequence: 2 givenname: Helen surname: So fullname: So, Helen organization: University of Alberta – sequence: 3 givenname: Peter W. surname: Wood fullname: Wood, Peter W. organization: University of Alberta – sequence: 4 givenname: Finlay A. surname: Mcalister fullname: Mcalister, Finlay A. organization: Mazankowski Heart Institute – sequence: 5 givenname: Muzaffar surname: Siddiqui fullname: Siddiqui, Muzaffar organization: University of Alberta – sequence: 6 givenname: Colleen M. surname: Norris fullname: Norris, Colleen M. organization: University of Alberta – sequence: 7 givenname: Tom surname: Jeerakathil fullname: Jeerakathil, Tom organization: Alberta Health Services Cardiovascular Health and Stroke Strategic Clinical Network – sequence: 8 givenname: James surname: Stone fullname: Stone, James organization: Alberta Health Services Cardiovascular Health and Stroke Strategic Clinical Network – sequence: 9 givenname: Shelley surname: Valaire fullname: Valaire, Shelley organization: Alberta Health Services Cardiovascular Health and Stroke Strategic Clinical Network – sequence: 10 givenname: Balraj surname: Mann fullname: Mann, Balraj organization: Alberta Health Services Cardiovascular Health and Stroke Strategic Clinical Network – sequence: 11 givenname: Pierre surname: Boulanger fullname: Boulanger, Pierre organization: University of Alberta – sequence: 12 givenname: Scott W. surname: Klarenbach fullname: Klarenbach, Scott W. organization: University of Alberta |
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Keywords | pharmacist case management secondary prevention hypertension stroke blood pressure telemonitoring |
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Snippet | Home blood pressure (BP) telemonitoring and pharmacist case management reduce BP, but cost‐effectiveness assessments are mixed. We examined the incremental... Home blood pressure (BP) telemonitoring and pharmacist case management reduce BP, but cost-effectiveness assessments are mixed. We examined the incremental... Home blood pressure ( BP ) telemonitoring and pharmacist case management reduce BP , but cost‐effectiveness assessments are mixed. We examined the incremental... |
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SubjectTerms | Aged Aged, 80 and over Blood Pressure Determination - economics blood pressure telemonitoring Canada case management Case Management - economics Cerebrovascular Disorders - mortality Cerebrovascular Disorders - prevention & control Cost-Benefit Analysis Female Humans hypertension Hypertension - complications Hypertension - diagnosis Male Markov Chains Middle Aged Mortality Original Paper Out of Office Blood Pressure Measurement pharmacist Pharmacists Quality-Adjusted Life Years secondary prevention Secondary Prevention - economics stroke Telemedicine - economics |
Title | Cost‐effectiveness of home blood pressure telemonitoring and case management in the secondary prevention of cerebrovascular disease in Canada |
URI | https://onlinelibrary.wiley.com/doi/abs/10.1111%2Fjch.13459 https://www.ncbi.nlm.nih.gov/pubmed/30570200 https://search.proquest.com/docview/2159326434 https://pubmed.ncbi.nlm.nih.gov/PMC8030339 |
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