Cost–Benefit Analysis of Home Blood Pressure Monitoring in Hypertension Diagnosis and Treatment: An Insurer Perspective
Abstract
Home blood pressure (BP) monitoring has been shown to be more effective than clinic BP monitoring for diagnosing and treating hypertension. However, reimbursement of home BP monitoring is uncommon in the United States because of a lack of evidence that it is cost beneficial for insurers. We develop a decision-analytic model, which we use to conduct a cost–benefit analysis from the perspective of the insurer. Model inputs are derived from the 2008 to 2011 claims data of a private health insurer in the United States, from 2009 to 2010 National Health and the Nutrition Examination Survey data, and from published meta-analyses. The model simulates the transitions among health states from initial physician visit to hypertension diagnosis, to treatment, to hypertension-related cardiovascular diseases, and patient death or resignation from the plan. We use the model to estimate cost–benefit ratios and both short- and long-run return on investment for home BP monitoring compared with clinic BP monitoring. Our results suggest that reimbursement of home BP monitoring is cost beneficial from an insurer’s perspective for diagnosing and treating hypertension. Depending on the insurance plan and age group categories considered, estimated net savings associated with the use of home BP monitoring range from $33 to $166 per member in the first year and from $415 to $1364 in the long run (10 years). Return on investment ranges from $0.85 to $3.75 per dollar invested in the first year and from $7.50 to $19.34 per dollar invested in the long run.
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The median ROI for healthcare public health interventions was 5.1.
“The ROI median was 5.1, and ranged from 1.1517 to 19.35.18”
From Return on investment of public health interventions: a systematic review (2017) · cites this paper as [18]
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Nesbitt, S. D. (2025) · Exploration of Medicine · doi:10.37349/emed.2025.1001337
Meurer, W. J., Dinh, M., Kidwell, K., Flood, A., Champoux, E., Whitfield, C., Trimble, D., Cowdery, J. E., Borgialli, D. A., Montas, S. M., et al. (2020) · Figshare · doi:10.6084/m9.figshare.12421775
Meurer, W. J., Dinh, M., Kidwell, K., Flood, A., Champoux, E., Whitfield, C., Trimble, D., Cowdery, J. E., Borgialli, D. A., Montas, S. M., et al. (2020) · Figshare · doi:10.6084/m9.figshare.12421772
Meurer, W. J., Dinh, M., Kidwell, K., Flood, A., Champoux, E., Whitfield, C., Trimble, D., Cowdery, J. E., Borgialli, D. A., Montas, S. M., et al. (2020) · Figshare · doi:10.6084/m9.figshare.12421745
Meurer, W. J., Dinh, M., Kidwell, K., Flood, A., Champoux, E., Whitfield, C., Trimble, D., Cowdery, J. E., Borgialli, D. A., Montas, S. M., et al. (2020) · Figshare · doi:10.6084/m9.figshare.12421757
Meurer, W. J., Dinh, M., Kidwell, K., Flood, A., Champoux, E., Whitfield, C., Trimble, D., Cowdery, J. E., Borgialli, D. A., Montas, S. M., et al. (2020) · Figshare · doi:10.6084/m9.figshare.12421763
Meurer, W. J., Dinh, M., Kidwell, K., Flood, A., Champoux, E., Whitfield, C., Trimble, D., Cowdery, J. E., Borgialli, D. A., Montas, S. M., et al. (2020) · Figshare · doi:10.6084/m9.figshare.12421781
Moosa, A. S., Peh, R. W. C., Oka, P., & Ng, C. J. (2026) · Journal of Primary Care & Community Health · doi:10.1177/21501319261492882
- Authors
- Arrieta, A., Woods, J. R., Qiao, N., & Jay, S. J.
- Affiliations
- Indiana University Health (US)
- Venue
- Hypertension
- Published
- 2014-10
- Volume
- 64
- Issue
- 4
- Pages
- 891-896
- ISSN
- 0194-911X (ISSN-L)
- 1524-4563
- OpenAlex
- W2102547927
- Cited by
- 75
- References
- 30
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 6 · 2023: 10 · 2022: 4 · 2021: 6 · 2020: 15 · 2019: 8 · 2018: 4 · 2017: 10 · 2016: 1 · 2015: 6
- FWCI
- 3.87
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Hypertension (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Indiana Clinical and Translational Sciences Institute
- Indiana University Health
- School of Medicine, Indiana University
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
- Keywords
- home blood pressure monitoring, hypertension diagnosis, antihypertensive therapy, cost-benefit analysis, insurance reimbursement, return on investment, decision-analytic model, cardiovascular disease, health state transitions
- MeSH terms
- Adult, Aged, Cost-Benefit Analysis, Female, Humans, Hypertension, Insurance Carriers, Insurance, Health, Reimbursement, Male, Middle Aged, United States, Blood Pressure Monitoring, Ambulatory, Models, Economic, Young Adult
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