Cost-effectiveness of the introduction of home blood pressure measurement in patients with office hypertension

Objective Cost-effectiveness of hypertension treatment is an important social and medical issue in Western as well as in Eastern countries, including Japan. Home blood pressure (HBP) measurements have a stronger predictive power for cardiovascular events than casual clinic blood pressure (CBP) measurements. Therefore, the introduction of HBP measurement for the diagnosis and treatment of hypertension should lead to a decrease in medical expenditure. This study presents calculations of the cost savings likely to take place when HBP is implemented for newly detected hypertensive subjects in Japan. Design and methods We estimate the cost savings from the perspective of a Japanese healthcare system. To estimate the costs associated with changing from CBP to HBP measurement as the diagnostic tool, we constructed a simulation model using data from the Ohasama study. These calculations are based on current estimates for cost of treatment, prevalence of white-coat hypertension at baseline, and varying the incidence of new hypertension after the initial screening. Results When HBP measurement is not incorporated into the diagnostic process, the medical cost is estimated at US$ 10.89 million per 1000 subjects per 5 years. When HBP measurement is incorporated, the medical cost is estimated at US$ 9.33 million per 1000 subjects per 5 years. The reductions in medical costs vary from US$ 674 000 to US$ 2.51 million per 1000 subjects per 5 years for treatment of hypertension, when sensitivity analysis is performed. Conclusions The introduction of HBP measurement for the treatment of hypertension is very useful for reducing medical costs.