• Hidefumi Fukunaga, Takayoshi Ohkubo, Makoto Kobayashi, Yuichiro Tamaki, Masahiro Kikuya, Taku Obara, Miwa Nakagawa, Azusa Hara, Kei Asayama, Hirohito Metoki, Ryusuke Inoue, Junichiro Hashimoto, Kazuhito Totsune, and Yutaka Imai.
• Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences and Medicine, Sendai, Japan.
• J. Hypertens. 2008 Apr 1; 26 (4): 685-90.

ObjectiveCost-effectiveness of hypertension treatment is an important social and medical issue in Western as well as in Eastern countries, including Japan. Home blood pressure (HBP) measurements have a stronger predictive power for cardiovascular events than casual clinic blood pressure (CBP) measurements. Therefore, the introduction of HBP measurement for the diagnosis and treatment of hypertension should lead to a decrease in medical expenditure. This study presents calculations of the cost savings likely to take place when HBP is implemented for newly detected hypertensive subjects in Japan.Design And MethodsWe estimate the cost savings from the perspective of a Japanese healthcare system. To estimate the costs associated with changing from CBP to HBP measurement as the diagnostic tool, we constructed a simulation model using data from the Ohasama study. These calculations are based on current estimates for cost of treatment, prevalence of white-coat hypertension at baseline, and varying the incidence of new hypertension after the initial screening.ResultsWhen HBP measurement is not incorporated into the diagnostic process, the medical cost is estimated at US$10.89 million per 1000 subjects per 5 years. When HBP measurement is incorporated, the medical cost is estimated at US$9.33 million per 1000 subjects per 5 years. The reductions in medical costs vary from US$674,000 to US$2.51 million per 1000 subjects per 5 years for treatment of hypertension, when sensitivity analysis is performed.ConclusionsThe introduction of HBP measurement for the treatment of hypertension is very useful for reducing medical costs.

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