Clinical usefulness and cost effectiveness of home blood... : Journal of Hypertension (original) (raw)

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Clinical usefulness and cost effectiveness of home blood pressure telemonitoring

meta-analysis of randomized controlled studies

Omboni, Stefanoa; Gazzola, Tizianaa; Carabelli, Giorgiaa; Parati, Gianfrancob,c

aItalian Institute of Telemedicine, Varese

bDepartment of Cardiology, IRCCS Ospedale San Luca, Istituto Auxologico Italiano

cDepartment of Clinical Medicine and Prevention, University of Milano Bicocca, Milano, Italy

Correspondence to Stefano Omboni, MD, Italian Institute of Telemedicine, Via Colombera 29, 21048 Solbiate Arno (Varese), Italy. Tel: +39 0331 984529; fax: +39 0331 984530; e-mail: [email protected]

Abbreviations: BP, blood pressure; HBPM, home blood pressure monitoring; HBPT, home blood pressure telemonitoring; MCS, mental component summary; MeSH, medical subject headings; PCS, physical component summary; PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses

Received 4 June, 2012

Revised 30 September, 2012

Accepted 15 November, 2012

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Abstract

Objective:

To systematically review data from randomized controlled studies on the effectiveness of home blood pressure telemonitoring (HBPT) versus usual care with respect to improvement of BP control, healthcare resources utilization and costs, patient's quality of life and adverse events.

Methods:

Electronic databases were searched for publications in English. The benefit and relative risk (RR) were estimated applying a random-effect model.

Results:

Twenty-three randomized controlled trials with a high level of heterogeneity were selected (7037 patients). Compared to usual care, HBPT improved office SBP by 4.71 mmHg [95% confidence interval (CI): 6.18, 3.24; P < 0.001] and DBP by 2.45 mmHg (3.33, 1.57; P < 0.001). A larger proportion of patients achieved office BP normalization (<140/90 mmHg nondiabetic patients and <130/80 mmHg diabetic patients) in the intervention group [RR: 1.16 (1.04, 1.29); P < 0.001]. HBPT led to a significantly larger prescription of antihypertensive medications [+0.40 (+0.17,+0.62), P < 0.001], but to therapeutic adherence and rate of office consultations similar to usual care. Healthcare costs were significantly (P < 0.001) larger in the HBPT group [+662.92 (+540.81, +785.04) euros per patient], but were similar to those of the usual care when only medical costs were considered [−12.4 (−930.52, +906.23) euros; P = 0.767]. Use of HBPT helped improving the physical component of quality of life [SF-12 or SF-36 questionnaire: +2.78 (+1.15, +4.41) P < 0.001]. No difference was observed in the risk of adverse events [RR: 1.22 (0.86, 1.71); P = 0.111].

Conclusion:

HBPT may represent a useful tool to improve hypertension control and associated healthcare outcomes, although it is still more costly compared with usual care.