Research Article Cost estimation of hypertension management based on home blood pressure monitoring alone or combined office and ambulatory blood pressure measurements Nadia Boubouchairopoulou, MSc a , Nikos Karpettas, MD b , Kostas Athanasakis, PhD a , Anastasios Kollias, MD b , Athanase D. Protogerou, MD c , Apostolos Achimastos, MD b , and George S. Stergiou, MD, FRCP b, * a Department of Health Economics, National School of Public Health, Athens, Greece; b Hypertension Center, STRIDE Hellas-7, Third University Department of Medicine, Sotiria Hospital, Athens, Greece; and c Hypertension Unit and Cardiovascular Research Lab, First Department of Internal and Propaedeutic Medicine, Laiko Hospital, Athens, Greece Manuscript received May 5, 2014 and accepted July 9, 2014 Abstract This study aims at estimating the resources consumed and subsequent costs for hypertension management, using home blood pressure (BP) monitoring (HBPM) alone versus combined clinic measurements and ambulatory blood pressure monitoring (C/ABPM). One hundred sixteen untreated hypertensive subjects were randomized to use HBPM or C/ABPM for antihyper- tensive treatment initiation and titration. Health resources utilized within 12-months follow-up, their respective costs, and hypertension control were assessed. The total cost of the first year of hypertension management was lower in HBPM than C/ABPM arm (V1336.0 vs. V1473.5 per subject, respectively; P < .001). Laboratory tests’ cost was identical in both arms. There was no difference in achieved BP control and drug expenditure (HBPM: V233.1 per subject; C/ABPM: V247.6 per sub- ject; P ¼ not significant), whereas the cost of BP measurements and/or visits was higher in C/ABPM arm (V393.9 vs. V516.9, per patient, respectively P < .001). The cost for subsequent years (>1) was V348.9 and V440.2 per subject, respectively for HBPM and C/ABPM arm and V2731.4 versus V3234.3 per subject, respectively (P < .001) for a 5-year projection. HBPM used alone for the first year of hypertension management presents lower cost than C/ABPM, and the same trend is observed in 5-year projection. The results on the resources consumption can be used to make cost estimates for other health-care systems. J Am Soc Hypertens 2014;8(10):732–738. Ó 2014 American Society of Hypertension. All rights reserved. Keywords: Blood pressure measurement methods; cost effectiveness; economic analysis; hypertension treatment. Introduction The diagnosis of hypertension and the evaluation of treatment-induced effects on blood pressure (BP) and target-organ damage have been based for decades on con- ventional office BP measurement. It is now, however, recog- nized that these measurements are often misleading due to the white-coat and masked hypertension phenomena, the poor reproducibility of office measurements and observer is- sues such as prejudice and bias. 1 Studies have shown that out-of-office measurements, using 24-hour ambulatory BP (ABP) monitoring (ABPM) or self-monitoring by patients at home, are more reliable than office measurements, have higher reproducibility, and higher diagnostic value, and therefore reflect more accurately preclinical target-organ damage 2 and the risk of cardiovascular events. 3–6 Both home blood pressure (HBP) monitoring (HBPM) and ABPM record BP in multiple occasions and in the usual environment of each subject, away from the office environ- ment. 1,5,6 However, ABP records BP data only for 24 hours but during all the individual’s kinds of activities including sleep, whereas HBP provides readings for several days, Funding Source: No funding was provided for this project. Conflict of Interest: None for all authors. *Corresponding author: George S. Stergiou, MD, FRCP, Hypertension Center, STRIDE Hellas-7, Third University Depart- ment of Medicine, Sotiria Hospital, 152 Mesogion Avenue, Athens 11527, Greece. Tel: þ302107763117; fax: þ302107719981. E-mail: gstergi@med.uoa.gr Journal of the American Society of Hypertension 8(10) (2014) 732–738 1933-1711/$ - see front matter Ó 2014 American Society of Hypertension. All rights reserved. http://dx.doi.org/10.1016/j.jash.2014.07.027