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Home blood pressure monitoring is cost-effective for insurers and should be reimbursed, researchers argued.

Estimated net savings ranged from $33 to $166 per person in the first year after getting a blood pressure device for use at home, depending on the insurance plan and age group categories considered, , of Florida International University in Miami, and colleagues found.

Over a decade, that , the group reported in the October issue of Hypertension: Journal of the American Heart Association.

That's "strong evidence" for private insurers to reimburse home blood pressure monitoring, promote its use to cut their own costs in the short- and long-term, and to improve healthcare quality, they argued.

The noninvasive gold standard, 24-hour ambulatory blood pressure monitoring probably won't ever be reimbursed routinely for diagnosis due to labor and equipment costs, they noted.

But home self-monitoring is nearly as accurate in diagnosis and is recommended by the American Heart Association and other groups as a routine adjunct to traditional office-based monitoring, they pointed out.

They developed a model for cost analysis based on the 2008 to 2011 claims from a private employee health insurance plan with 25,478 members and a Medicare Advantage plan with 8,253 members, together with data from the 2009-2010 National Health and the Nutrition Examination Survey and from published meta-analyses.

The authors considered only the reimbursement costs of wholesale purchase of upper-arm blood pressure monitors, and assumed a lifespan of 5 years for the equipment, plus the expense of running a campaign to make members aware of their availability.

In the first year, the net savings were projected at $33.75 per insured member ages 20 to 44, $32.65 per 45- to 64-year-old, and $166.17 per member 65 and older.

The return on investment was $0.94 per dollar invested for the younger group, $0.85 for the middle-age group, and $3.75 among the seniors.

Over a decade, the net savings was again greatest in the oldest group ($1,364.27) but still positive in the two younger groups ($414.81 and $439.14).

The return on investment over the long run was $7.50 to $19.34 per dollar invested, following the same pattern.

Use only for diagnosis was beneficial in every category, whereas use only for monitoring treatment mainly was projected to save the health plans money in the Medicare-age group and toward the end of the decade of use in the younger groups.

"The diagnosis-related savings observed in younger individuals can be explained by noting that home blood pressure monitoring has better diagnostic specificity than clinic blood pressure monitoring, which translates into lower costs because of fewer false-positive diagnoses and fewer people entering unnecessary lifelong treatment," the researchers explained.

"In high-prevalence populations (those ages ≥65 years), the impact of home blood pressure monitoring's better specificity is diluted because if most members are hypertensive, there will be more positive diagnoses that are correct in absolute terms regardless of the diagnostic method used."

The results were conservative estimates, the researchers noted, because simulation was based on only the most common hypertension-related cardiovascular disease events that contribute to costs and did not consider the cost of treating false-positive hypertension cases.

The study also didn't include provider-related costs, such as for device validation, patient training, and communication with patients, which would have increased the reimbursement cost estimates but would also increase the effectiveness of home monitoring and boosted the net savings, they added.

From the American Heart Association:

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