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2011 HSR&D National Meeting Abstract

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2011 National Meeting

1081 — Cost Analysis of a Four-Arm Home- and Telephone-Based Intervention for Blood Pressure Management among Primary Care Patients with Hypertension

Wang V (COE Durham), Smith VA (COE Durham), Oddone EZ (COE Durham), Olsen MK (COE Durham), McCant F (COE Durham), Van Houtven CH (COE Durham)

Objectives:
Home- and telephone-based interventions have the potential to improve clinical outcomes and reduce health system costs. This study evaluates the costs of The Hypertension Intervention Nurse Telemedicine Study (HINTS), aimed to improve blood pressure (BP) control in veterans.

Methods:
Eligible veterans were randomized to either usual care or one of three telephone-based intervention groups using home BP telemonitoring: 1) behavioral management; 2) medication management; or 3) combined. We estimated medical costs at 18 months by group using VHA Decision Support System data. Distinctions were made between inpatient, outpatient, and outpatient pharmacy costs, including for hypertension-specific pharmacy costs. Intervention and patient time costs were derived using information collected during the trial. Total costs included medical, patient time, and intervention domains. Non-parametric bootstrapped confidence intervals were computed to compare costs between intervention groups and usual care.

Results:
Intervention costs per patient were similar: $933 (behavioral management), $1,097 (medication management) and $1,104 (combined); patient time costs averaged $450 per patient. At 18-month follow-up there were no statistically significant differences in total VA resource utilization costs between treatment arms and usual care. Compared to usual care, patients receiving behavioral management incurred $675 (CI: $134, $1,985) more in outpatient pharmacy; patients in the medication management arm spent $84 (CI: $12, $162) more in hypertension-related pharmacy costs. Total intervention costs per patient were not significantly different from usual care ($17,077 behavioral management; $16,510 medication management; $15,314 combined; $13,847 for usual care).

Implications:
HINTS showed significant gains in BP control at 12 months for the behavior and medication management arms, along with improvements in systolic BP in the combined arm, but BP control was similar across all groups at 18 months. Total medical resource costs and total costs for treatment arms were no different from usual care at 18 months.

Impacts:
Although total costs were similar between the four groups, per patient intervention costs were high and BP control was no different from usual care at 18 months. It is vital to identify the patients that are most likely to benefit from more intensive home BP management, in order to optimize investment in home- and telephone-based interventions such as HINTS.


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