Adding pharmacist to web-based care still cost-effective

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 - High blood pressure, hypertension

A web-based program for managing patients with high blood pressure that included a pharmacist component was cost-effective, according to a study published online Sept. 16 in the American Journal of Managed Care.

Researchers from the Group Health Research Institute in Seattle previously reported on the success of the Electronic Communications and Home Blood Pressure Monitoring to Improve Blood Pressure Control trial. They randomized patients in the Group Health Cooperative who were diagnosed with hypertension and were on medications to one of three groups: usual care; usual care plus home blood pressure monitoring (BPM); and usual care, home blood pressure monitoring plus pharmacist care (e-BP).

They found that blood pressure control improved in 56 percent of the e-BP group, 36 percent of the BPM group and 31 percent of the usual care group. The e-BP group experienced the greatest reduction in systolic and diastolic blood pressure.

Paul A. Fishman, PhD, et al applied the results to a cost-effectiveness analysis, looking at blood pressure control, reduction in systolic and diastolic blood pressure and change in life expectancy due to the intervention as outcomes. They used usual care as the reference.

The mean costs of usual care, BPM and e-BP were $10.56, $67.36 and $400.36 per patient, respectively. The incremental cost-effectiveness ratio for e-BP compared to BPM was $16.65 for every 1 percent increase in the percentage of patients under blood pressure control; $65.29 and $114.82 per every mm HG decrease in systolic and diastolic blood pressure; and $1,850 for every year of life saved in men and $2,220 for every year of life saved in women.

“We demonstrated that it is possible to significantly improve hypertension control with a program that is relatively low cost,” they wrote.

Their integrated healthcare system already had invested in an EMR and other necessary technology. Systems without that infrastructure would need to invest the technology, Fishman and colleagues pointed out, which would affect cost savings. Most of their patient population was white, college educated and computer literate, which also affects the generalizability of their results.