Cost-effectiveness analysis of an mHealth intervention to improve hypertension control in patients with elevated cardiovascular risk
M T Caputo, K Lakshminarayan, B Sakboonyarat, S M Westberg, S A Everson-Rose, T McCarthy, C Streib, P Drawz, T A MurrayAbstract
Background
This study evaluates the cost-effectiveness of a mobile health technology (mHealth) based care model to facilitate home blood pressure (BP) monitoring and remote hypertension management.
Methods
We used a Markov microsimulation model to study health and cost outcomes for three hypertension control strategies: an mHealth-based care model (mGlide) vs. Enhanced Usual Care (EUC) vs. No-Intervention. We sampled patient characteristics from the mGlide randomized controlled trial (RCT) and randomly transitioned patients through three possible health states over a 10-year horizon with monthly cycles: 1) No Cardiovascular Event, 2) Cardiovascular Event, and 3) Deceased. We determined transition probabilities from literature, allowing the probabilities to vary by patient characteristics, including BP values. We evaluated health and cost outcomes across a range of plausible deterministic treatment effects (expected BP reductions) supported by the RCT. We performed probabilistic sensitivity analysis to assess cost-effectiveness while randomly varying the treatment effect magnitude.
Results
The mHealth-based care model was cost-effective compared to No-Intervention and EUC across all deterministic scenarios. 10-year mortality absolute risk reductions ranged from 4.9-5.8% (vs No-Intervention) and 0.6-3.3% (vs EUC) across scenarios. In probabilistic sensitivity analysis, mHealth-based care (vs EUC) was less costly in 59.6% of iterations and had better health outcomes in 99.6%. Comparing all care models, mHealth-based care had the greatest net monetary benefit in 95% of iterations at $26,000/QALY and in 99% of iterations at $72,000/QALY.
Conclusions
In the current study, we estimated that mHealth-based care models can be cost-effective approaches to improve hypertension control in patients with elevated cardiovascular risk.