Dehmer Steven P, Maciosek Michael V, Trower Nicole K, Asche Stephen E, Bergdall Anna R, Nyboer Rachel A, O'Connor Patrick J, Pawloski Pamela A, Sperl-Hillen JoAnn M, Green Beverly B, Margolis Karen L
HealthPartners Institute, Minneapolis, MN.
Kaiser Permanente Washington Health Research Institute, Seattle, WA.
J Am Coll Clin Pharm. 2018 Oct;1(1):21-30. doi: 10.1002/jac5.1001. Epub 2018 Apr 14.
Pharmacist-managed (team-based) care for hypertension with home blood pressure monitoring support interventions have been widely studied and shown to be effective in improving rates of hypertension control and lowering blood pressure; however, few studies have evaluated the economic considerations related to bringing these programs into usual practice.
To analyze the economic outcomes of the Blood Pressure Telemonitoring and Pharmacist Management on Blood Pressure (Hyperlink) study, a cluster randomized controlled trial which used home blood pressure telemonitoring and pharmacist case management to achieve better blood pressure control in patients with uncontrolled hypertension.
A prospective analysis compared differences in medical costs and encounters in the Hyperlink telemonitoring intervention and usual care groups in the 12 months pre- and post-enrollment using medical and pharmacy insurance claims from a health care sector perspective. Generalized estimating equation models were used to estimate differences between groups over time. These results, combined with previously published prospective study results on intervention costs and blood pressure outcomes, were used to estimate cost-effectiveness measures for blood pressure control and reduction.
Total medical costs in the intervention group were lower compared with the usual care group by an average of $281 per person, but this difference was not statistically significant. Clinic-based office visit, radiology, pharmacy, and hospital costs were also non-significantly lower in the intervention group. Statistically significant differences were found in lipid-related laboratory costs (higher) and in hypertension- (higher) and lipid-related (lower) pharmacy costs. Patterns in medical costs were similar for medical encounters. On average, the intervention cost $7337 per person achieving hypertension control and $139 or $265 per mm Hg reduction in systolic or diastolic blood pressure, respectively.
Home blood pressure monitoring and pharmacist case management to improve hypertension care can be implemented without increasing, and potentially reducing, overall medical care costs.
药师管理（团队式）的高血压护理并辅以家庭血压监测支持干预措施已得到广泛研究，并显示在提高高血压控制率和降低血压方面有效；然而，很少有研究评估将这些项目纳入常规实践的经济考量。
分析血压远程监测与药师血压管理（超链接）研究的经济结果，这是一项整群随机对照试验，该试验采用家庭血压远程监测和药师病例管理，以在未控制高血压患者中实现更好的血压控制。
一项前瞻性分析从医疗保健部门角度，利用医疗和药房保险理赔数据，比较了超链接远程监测干预组和常规护理组在入组前和入组后12个月的医疗费用和诊疗次数差异。使用广义估计方程模型来估计随时间推移组间差异。这些结果，结合先前发表的关于干预成本和血压结果的前瞻性研究结果，用于估计血压控制和降低的成本效益指标。
干预组的总医疗费用与常规护理组相比，平均每人低281美元，但这一差异无统计学意义。干预组基于诊所的门诊、放射学、药房和住院费用也略低但无统计学意义。在血脂相关实验室检查费用（较高）以及高血压相关（较高）和血脂相关（较低）药房费用方面发现了统计学显著差异。医疗诊疗次数的医疗费用模式相似。平均而言，干预措施实现高血压控制的人均成本为7337美元，收缩压或舒张压每降低1mmHg的成本分别为139美元或265美元。
家庭血压监测和药师病例管理以改善高血压护理可以在不增加甚至可能降低总体医疗费用的情况下实施。
