• Paul A Fishman, Andrea J Cook, Melissa L Anderson, James D Ralston, Sheryl L Catz, David Carrell, James Carlson, and Beverly B Green.
• Group Health Cooperative, Group Health Research Institute, 1730 Minor Ave, Seattle, WA 98101. E-mail: fishman.p@ghc.org.
• Am J Manag Care. 2013 Sep 1; 19 (9): 709-16.

BackgroundWeb-based collaborative approaches to managing chronic illness show promise for both improving health outcomes and increasing the efficiency of the healthcare system.ObjectiveAnalyze the cost-effectiveness of the Electronic Communications and Home Blood Pressure Monitoring to Improve Blood Pressure Control (e-BP) study, a randomized controlled trial that used a patient-shared electronic medical record, home blood pressure (BP) monitoring, and web-based pharmacist care to improve BP control (<140/90 mm Hg).Study DesignIncremental cost-effectiveness analysis conducted from a health plan perspective.MethodsCost-effectiveness of home BP monitoring and web-based pharmacist care estimated for percent change in patients with controlled BP and cost per mm Hg in diastolic and systolic BP relative to usual care and home BP monitoring alone.ResultsA 1% improvement in number of patients with controlled BP using home BP monitoring and web-based pharmacist care-the e-BP program-costs $16.65 (95% confidence interval: 15.37- 17.94) relative to home BP monitoring and web training alone. Each mm HG reduction in systolic and diastolic BP achieved through the e-BP program costs $65.29 (59.91-70.67) relativeto home BP monitoring and web tools only. Life expectancy was increased at an incremental cost of $1850 (1635-2064) and $2220 (1745-2694) per year of life saved for men and women, respectively.ConclusionsWeb-based collaborative care can be used to achieve BP control at a relatively low cost. Future research should examine the cost impact of potential long-term clinical improvements.

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