Cost-utility analysis of home blood pressure measurement for screening and diagnosis of hypertension through village health volunteer mechanism in Thailand

This study aimed to evaluate the cost-effectiveness of blood pressure (BP) screening strategies, including 1) home blood pressure measurement (HBPM), (2) serial screening by CBPM followed by HBPM among individuals with high BP i.e., clinic BP ≥140/90 mmHg (Serial1), (3) serial screening by CBPM followed by HBPM among individuals without high BP i.e., clinic blood pressure <140/90 mmHg (Serial2) compared to CBPM alone. A Markov model was applied among Thai population aged 35 years who had not been previously diagnosed with hypertension (HT) during a lifetime horizon with one-year cycle length from a societal perspective. One-way and probabilistic sensitivity analyses using Monte Carlo simulation with 1,000 replications were performed. The total cost of Serial2 (118,283 baht) was the highest and followed by HBPM (110,767 baht), CBPM (110,588 baht) and Serial1 (78,310 baht). The total quality adjusted life years (QALYs) for the population undergoing BP screening with CBPM, HBPM, Serial1, and Serial2 were 22.1557, 22.1511, 22.1286, and 22.1564, respectively. Compared to CBPM, Serial1 was associated with an incremental cost saving of 32,278 and an incremental QALY loss of 0.0271, whereas HBPM was dominated by CBPM due to higher cost (179 baht) and fewer QALY (-0.0046). Additionally, the incremental cost-effectiveness ratio (ICER) of Serial2 was the highest (10,992,000 baht per QALY gained). Moreover, the incidence rate of HT among individuals at age 40-49 years was the most sensitive factor influencing the ICER of HBPM, Serial1 and Serial2. At the Thai societal willingness-to-pay (WTP) threshold of 160,000 baht per QALY gained, the cost saving associated with Serial1 outweighed the QALY loss. Therefore, it is recommended that Serial1 be implemented as a BP screening option in Thailand. This evidence informed policy information could be invaluable for policymakers in making decision regarding BP screening through village health volunteer mechanism in Thailand and similar settings.