Economic analysis of a tailored behavioral intervention to improve blood pressure control for primary care patients.

Few telemedicine programs have undergone cost analyses, impeding their implementation into practice. We report on the economic analysis of a nurse-administered intervention designed to improve blood pressure control among hypertensive veterans. We randomized hypertensive patients at the Durham Veterans Affairs Medical Center primary care clinic to behavioral (n = 294) or nonbehavioral (n = 294) interventions. Behavioral intervention patients received tailored information bimonthly for 2 years via telephone. To calculate intervention cost, we microcosted the nurse's labor cost and computer hardware and software costs, applied a direct-to-indirect cost ratio, and distributed the costs over an estimated cohort of patients. We analyzed data from the Veterans Affairs Decision Support System to assess whether the intervention impacted overall health care utilization and costs. We used life expectancy estimates from the literature to develop decision models to calculate cost per life-year saved. The mean annual intervention cost was $112 (range $61-$259). During 2 years of follow-up, patients in the intervention group incurred $7,800 in inpatient costs and $9,741 in outpatient costs; the nonintervention group incurred $6,866 in inpatient costs and $9,599 in outpatient costs. The total cost difference was not statistically significant (P = .56). Cost-effectiveness of the behavioral intervention ranged from $42,457 per life-year saved for normal-weight women to $87,300 per life-year saved for normal-weight men. The study results suggest that a nurse-administered, tailored behavioral intervention can be implemented at nominal cost and be cost-effective; however, there was no apparent lowering of health care utilization and costs during the 2 years of follow-up.

Datta SK ，Oddone EZ ，Olsen MK ，Orr M ，McCant F ，Gentry P ，Bosworth HB ... -  《-》

Patient education and provider decision support to control blood pressure in primary care: a cluster randomized trial.

Bosworth HB ，Olsen MK ，Dudley T ，Orr M ，Goldstein MK ，Datta SK ，McCant F ，Gentry P ，Simel DL ，Oddone EZ ... -  《-》

Cost-effectiveness analysis of a rural telemedicine collaborative care intervention for depression.

Pyne JM ，Fortney JC ，Tripathi SP ，Maciejewski ML ，Edlund MJ ，Williams DK ... -  《-》

The veterans' study to improve the control of hypertension (V-STITCH): design and methodology.

Bosworth HB ，Olsen MK ，Goldstein MK ，Orr M ，Dudley T ，McCant F ，Gentry P ，Oddone EZ ... -  《Contemporary Clinical Trials》

Economic evaluation of telephone self-management interventions for blood pressure control.

Half of patients with hypertension have poor blood pressure (BP) control. Recent models for treating hypertension have integrated disease monitoring and telephone-based interventions delivered in patients' homes. This study evaluated the costs of the Hypertension Intervention Nurse Telemedicine Study (HINTS), aimed to improve BP control in veterans. Eligible veterans were randomized to either usual care or 1 of 3 telephone-based intervention groups using home BP telemonitoring: (1) behavioral management, (2) medication management, or (3) combined. Intervention costs were derived from information collected during the trial. Direct medical costs (inpatient, outpatient, and outpatient pharmacy, including hypertension-specific pharmacy) at 18 months by group were calculated using Veterans Affairs (VA) Decision Support System data. Bootstrapped CIs were computed to compare intervention and medical costs between intervention groups and usual care. Patients receiving behavior or medication management showed significant gains in BP control at 12 months; there were no differences in BP control at 18 months. In subgroup analysis, patients with poor baseline BP control receiving combined intervention significantly improved BP at 12 and 18 months. In overall and subgroup samples, average intervention costs were similar in the 3 study arms, and at 18 months, there were no statistically significant differences in direct VA medical costs or total VA costs between treatment arms and usual care. To optimize investment in telephone-based home interventions such as the HINTS, it is important to identify groups of patients who are most likely to benefit from more intensive home BP management.

Wang V ，Smith VA ，Bosworth HB ，Oddone EZ ，Olsen MK ，McCant F ，Powers BJ ，Van Houtven CH ... -  《-》