The Take Control of Your Blood Pressure trial evaluated the effect of a multicomponent telephonic behavioral lifestyle intervention, patient self-monitoring, and both interventions combined compared with usual care on reducing systolic blood pressure during 24 months.

The combined intervention led to a significant reduction in systolic blood pressure compared with usual care alone. We examined direct and patient time costs associated with each intervention.

We conducted a prospective economic evaluation alongside a randomized controlled trial of 636 patients with hypertension participating in the study interventions.

Medical costs were estimated using electronic data representing medical services delivered within the health system. Intervention-related costs were derived using information collected during the trial, administrative records, and published unit costs.

During 24 months, patients incurred a mean of $6,965 (s.d., $22,054) in inpatient costs and $8,676 (s.d., $9,368) in outpatient costs, with no significant differences among the intervention groups.

With base-case assumptions, intervention costs were estimated at $90 (s.d., $2) for home blood pressure monitoring, $345 (s.d., $64) for the behavioral intervention ($31 per telephone encounter), and $416 (s.d., $93) for the combined intervention.

Patient time costs were estimated at $585 (s.d., $487) for home monitoring, $55 (s.d., $16) for the behavioral intervention, and $741 (s.d., $529) for the combined intervention.

Our analysis demonstrated that the interventions are cost-additive to the health-care system in the short term and that patients' time costs are nontrivial.

American Journal of Hypertension 2010; doi:10.1038/ajh.2009.215

blood pressure, costs and cost analysis, hypertension, patient compliance

Shelby D. Reed^1,2, Yanhong Li¹, Eugene Z. Oddone^2,3, Alice M. Neary³, Melinda M. Orr³, Janet M. Grubber^2,3, Felicia L. Graham¹, Maren K. Olsen^3,4, Laura P. Svetkey², Rowena J. Dolor^2,3, Benjamin J. Powers², Martha B. Adams² and Hayden B. Bosworth^2,3

1. ¹Center for Clinical and Genetic Economics, Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
2. ²Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
3. ³Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, North Carolina, USA
4. ⁴Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina, USA

Correspondence: Shelby D. Reed, (shelby.reed@duke.edu)

Received 29 July 2009; First Decision 28 August 2009; Accepted 14 October 2009; Published online 19 November 2009.