Home BP telemonitoring clinically effective, but costly

Kaiser Permanente's home blood pressure telemonitoring program helped patients achieve small reductions in blood pressure but drove up overall costs, a new analysis revealed.

Published in the American Journal of Managed Care, the study assessed Kaiser Permanente Southern California's remote patient monitoring program for hypertension. Prior research has shown that home-based BP monitoring measurements are accurate -- even more so than those taken in clinics -- and that they supported hypertension management during the COVID-19 pandemic. However, the new study calls into question the cost-effectiveness of these RPM programs.

For the study, researchers included 3,067 patients who participated in the home BP program between November 2019 and June 2022. Participants were instructed to measure their BP at home three days each week, four times a day, before taking antihypertensive medications. The BP readings were synced to a smartphone application, which directly transmitted the data to the EHR. Clinicians reviewed the readings and adjusted patients' medications accordingly.

The study participants were divided into two groups. Those who enrolled in the program and uploaded at least one BP reading were known as the intervention group, while those who enrolled but did not upload any readings were the usual care group.

Patients' adjusted mean systolic BP at enrollment was 142.80 mm Hg across both groups. Researchers found that at 12 months post enrollment, mean systolic BP was 135.39 mm Hg in the usual care group and 133.97 mm Hg in the intervention group. This means that program participants experienced an overall systolic BP reduction of 1.42 mm Hg.

However, the costs of enrolling patients in the program drove up overall program expenditures, the researchers found. The enrollment costs were estimated to be $113.35 per person, including approximately $80 for device and shipping and $32 for staff time to identify and schedule in-person and virtual appointments.

Though the program reduced in-person care costs for the intervention group, the reductions were modest -- $6.52 for hypertension-related office visits and $2.58 for BP clinic visits. At the same time, hypertension-related virtual encounters for the intervention group increased $11.80.

Thus, total hypertension-related healthcare costs increased from $30.46 to $36.23, on average, in the intervention group and from $26.00 to $29.06 in the usual care group.

"The costs associated with increased virtual encounters were small and offset by reductions of in-person hypertension-related visits, making the overall cost increase attributable to the HBPT [home BP telemonitoring] program enrollment expenses," the researchers concluded. "Future analyses should focus on the program's effectiveness in health-related outcomes and its cost-effectiveness."

The study comes as uncertainty swirls around the cost-effectiveness and return on investment (ROI) of digital health tools. While the clinical benefits of virtual care programs, including RPM services, are apparent, they do not necessarily result in significant ROI.

Anuja Vaidya has covered the healthcare industry since 2012. She currently covers the virtual healthcare landscape, including telehealth, remote patient monitoring and digital therapeutics.