TY  - JOUR
AU  - Wang, Yi
AU  - Tyagi, Shilpa
AU  - Ng, David Wei Liang
AU  - Teo, Valerie Hui Ying
AU  - Kok, David
AU  - Foo, Dennis
AU  - Koh, Gerald Choon-Huat
PY  - 2025
DA  - 2025/4/15
TI  - Primary Technology-Enhanced Care for Hypertension Scaling Program: Trial-Based Economic Evaluation Examining Effectiveness and Cost-Effectiveness Using Real-World Data in Singapore
JO  - J Med Internet Res
SP  - e59275
VL  - 27
KW  - telehealth monitoring
KW  - hypertension
KW  - cost-effectiveness analysis
KW  - real-world data
KW  - Singapore
KW  - telehealth
KW  - cost-effectiveness
KW  - blood pressure monitoring
KW  - health care
KW  - teleconsultation
KW  - chatbot
KW  - regression analysis
KW  - medical cost
AB  - Background: Telehealth interventions are effective in hypertension management. However, the cost-effectiveness of using them for managing patients with hypertension remains inconclusive. Further research is required to understand the effectiveness and cost-effectiveness in the real-world setting. Objective: The Primary Technology-Enhanced Care for Hypertension (PTEC-HT) scaling program, a telehealth intervention for hypertension management, is currently being scaled nationwide in Singapore. The program comprises remote blood pressure (BP) monitoring at home, health care team support through teleconsultations, and in-app support with a digital chatbot. This study aimed to evaluate the program’s effectiveness and cost-effectiveness. Methods: For patients under the PTEC-HT scaling program, BP readings over 6 months and 12 months, age, and gender were collected within the program. Health care use, health care cost, and patient ethnicity were extracted from the National Healthcare Group Polyclinics. For patients in the usual care group, demographic information, clinical data, health care use, and health care costs were extracted from the national claims records. Comparing the PTEC-HT scaling program with usual care, a trial-based economic evaluation using patient-level data was conducted to examine the effectiveness and cost-effectiveness over time horizons of 6 months and 12 months. The health care system’s perspective was adopted. Regression analysis and exact matching were used to control for the differences between the PTEC-HT group and the usual care group. Results: For the 6-month analysis, 427 patients were included in the PTEC-HT group, and 64,679 patients were included in the usual care group. For the 12-month analysis, 338 patients were included in the PTEC-HT group, and 7324 patients were included in the usual care group. Using exact matching plus regression, in the 6-month analysis, the probability of having controlled BP was 13.5% (95% CI 6.3%-20.7%) higher for the PTEC-HT group compared to the usual care group. In the 12-month analysis, the probability of having controlled BP was 16% (95% CI 10.7%-21.3%) higher for the PTEC-HT group. Without considering the cost of the BP machine and program maintenance cost, the direct medical cost was S $57.7 (95% CI 54.4-61.0; a currency exchange rate of S $1=US $0.74 was applicable;) lower per patient for the PTEC-HT group in the 6-month analysis and S $170.9 (95% CI 151.9-189.9) lower per patient for the PTEC-HT group in the 12-month analysis. With the cost of the BP machine and program maintenance considered, compared to usual care, the PTEC-HT program reached breakeven at around the sixth month and saved S $52.6 (95% CI 33.6-71.6) per patient at the 12th month. Conclusions: Implemented in a real-world setting in Singapore, our study showed that the PTEC-HT scaling program is more effective in controlling BP status with lower cost compared to the usual care over 12 months. 
SN  - 1438-8871
UR  - https://www.jmir.org/2025/1/e59275
UR  - https://doi.org/10.2196/59275
DO  - 10.2196/59275
ID  - info:doi/10.2196/59275
ER  -