Key result
Adoption of self-measured blood pressure monitoring would prevent nearly 16.5 million false positive hypertension diagnoses and save insurance plans $254 per member over a lifetime horizon when used for diagnosis, treatment selection, and monitoring combined.
Why the study?
Although patient self-measured blood pressure (SMBP) is known to be cost-effective for HTN diagnosis and control, it remains unknown which specific uses produce the most value.
Does self-measured blood pressure monitoring improve return on investment and net present value for insurers compared to clinic blood pressure monitoring in the US adult population?
Does self-measured blood pressure monitoring improve return on investment and net present value for insurers compared to clinic blood pressure monitoring in the US adult population?
Effect estimate: $254 per individual
Self-measured blood pressure monitoring provides a positive return on investment for insurers primarily by preventing false-positive hypertension diagnoses and optimizing treatment selection, rather than through ongoing treatment monitoring.
Previous research indicates that patient self-measured blood pressure (SMBP) is a cost-effective strategy for improving hypertension (HTN) diagnosis and control. However, it is unknown which specific uses of SMBP produce the most value. Our goal is to estimate, from an insurance perspective, the return-on-investment (ROI) and net present value associated with coverage of SMBP devices when used (a) only to diagnose HTN, (b) only to select and titrate medication, (c) only to monitor HTN treatment, or (d) as a bundle with all three uses combined. We employed national sample of claims data, Framingham risk predictions, and published sensitivity-specificity values of SMBP and clinic blood-pressure measurement to extend a previously-developed local decision-analytic simulation model. We then used the extended model to determine which uses of SMBP produce the most economic value when scaled to the U.S. adult population. We found that coverage of SMBP devices yielded positive ROIs for insurers in the short-run and at lifetime horizon when the three uses of SMBP were considered together. When each use was evaluated separately, positive returns were seen when SMBP was used for diagnosis or for medication selection and titration. However, returns were negative when SMBP was used exclusively to monitor HTN treatment. When scaled to the U.S. population, adoption of SMBP would prevent nearly 16.5 million false positive HTN diagnoses, thereby improving quality of care while saving insurance plans $254 per member. A strong economic case exists for insurers to cover the cost of SMBP devices, but it matters how devices are used.
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Arrieta et al. (2021) studied Hypertension (n=4,002,866). Self-measured blood pressure (SMBP) monitoring vs. Clinic blood pressure monitoring (CBPM) was evaluated on Lifetime Net Present Value (NPV) per individual from an insurance perspective ($254 per individual). Adoption of self-measured blood pressure monitoring would prevent nearly 16.5 million false positive hypertension diagnoses and save insurance plans $254 per member over a lifetime horizon when used for diagnosis, treatment selection, and monitoring combined.
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