Comparative Cost-Effectiveness of Clinic, Home, or Ambulatory Blood Pressure Measurement for Hypertension Diagnosis in US Adults: A Modeling Study
Abstract
Previous cost-effectiveness models found ambulatory blood pressure monitoring (ABPM) to be a favorable strategy to diagnose hypertension; however, they mostly focused on older adults with a positive clinic blood pressure (BP) screen. We evaluated the cost-effectiveness of 3 methods of BP measurement for hypertension diagnosis in primary care settings among 14 age- and sex-stratified hypothetical cohorts (adults ≥21 years of age), accounting for the possibility of both false-positive (white-coat hypertension) and false-negative (masked hypertension) clinic measurements. We compared quality-adjusted life-years and lifetime costs ($US 2017 from the US healthcare perspective) associated with clinic BP measurement, home BP monitoring, and ABPM under 2 scenarios: positive and negative initial screen. Model parameters were obtained from published literature, publicly available data sources, and expert input. In the screen-positive scenario, ABPM was the dominant strategy among all age and sex groups. Compared with clinic BP measurement, ABPM was associated with cost-savings ranging from $77 (women 80 years of age) to $5013 (women 21 years of age). In the screen-negative scenario, ABPM was the dominant strategy in all men and women <80 years of age with cost-savings ranging from $128 (women 70 years of age) to $2794 (women 21 years of age). Sensitivity analyses showed that results were sensitive to test specificity and antihypertensive medication costs. ABPM is recommended as the diagnostic strategy of choice for most adults in primary care settings regardless of initial screening results.
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Adoption of HBPM is still challenging because of barriers that involve cultural, structural and financial domains.
“Adoption of HBPM is still challenging because of barriers that involve three general domains: cultural, structural and financial [255–258].”
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- Authors
- Beyhaghi, H., & Viera, A. J.
- Affiliations
- University of North Carolina at Chapel Hill (US)
- Duke University (US)
- Venue
- Hypertension
- Published
- 2019-01
- Volume
- 73
- Issue
- 1
- Pages
- 121-131
- ISSN
- 0194-911X (ISSN-L)
- 1524-4563
- OpenAlex
- W2903955536
- Cited by
- 55
- References
- 0
- Citations by year
- 2026: 3 · 2025: 2 · 2024: 5 · 2023: 7 · 2022: 12 · 2021: 10 · 2020: 10 · 2019: 5 · 2018: 1
- FWCI
- 4.92
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Hypertension (publishedVersion)
- PubMed (publishedVersion)
- 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 › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Disease Prevention
- Keywords
- hypertension diagnosis, ambulatory blood pressure monitoring, home blood pressure monitoring, clinic blood pressure measurement, cost-effectiveness, white coat hypertension, masked hypertension, primary care, quality-adjusted life years, age and sex stratification
- MeSH terms
- Adult, Aged, Aged, 80 and over, Antihypertensive Agents, Blood Pressure Determination, Cost-Benefit Analysis, False Negative Reactions, False Positive Reactions, Female, Humans, Hypertension, Male, Middle Aged, Primary Health Care, Sensitivity and Specificity, United States, Health Care Costs, Blood Pressure Monitoring, Ambulatory, Quality-Adjusted Life Years
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