Cost-effectiveness of self-management of blood pressure in hypertensive patients over 70 years with sub-optimal control and established cardiovascular disease or additional CV risk diseases (TASMIN-SR)

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Cost-effectiveness of self-management of blood pressure in hypertensive patients over 70 years with sub-optimal control and established cardiovascular disease or additional CV risk diseases (TASMIN-SR). / Penaloza, Maria; Jowett, Sue; Mant, Jonathan; Schwartz, Claire; Bray, Emma; Haque, Mohammad; Hobbs, F. D. Richard; Little, Paul; Bryan, Stirling; Williams, Bryan; McManus, Richard J.

In: European journal of preventive cardiology, Vol. 23, No. 9, 06.2016, p. 902-12.

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@article{417099ebb93d4037bd1143f75c9fe3d8,
title = "Cost-effectiveness of self-management of blood pressure in hypertensive patients over 70 years with sub-optimal control and established cardiovascular disease or additional CV risk diseases (TASMIN-SR)",
abstract = "Background: A previous economic analysis of self-management, that is, self-monitoring with self-titration of antihypertensive mediation evaluated cost-effectiveness among patients with uncomplicated hypertension. This study considered cost-effectiveness of self-management in those with raised blood pressure plus diabetes, chronic kidney disease (CKD) and/or previous cardiovascular disease.Design and methods: A Markov model-based economic evaluation was undertaken to estimate the long-term cost-effectiveness of self-management of blood pressure in a cohort of 70-year old {\textquoteleft}high risk{\textquoteright} patients, compared with usual care. The model used the results of the TASMIN-SR trial. A cost-utility analysis was undertaken from a UK health and social care perspective, taking into account lifetime costs of treatment, cardiovascular events and quality adjusted life years (QALYs). A sub-group analysis ran the model separately for men and women. Deterministic sensitivity analyses examined the effect of different time horizons and reduced effectiveness of self-management.Results: Base-case results indicated that self-management was cost-effective compared with usual care, resulting in more QALYs (0.21) and cost savings (-£830) per patient. There was a 99% chance of the intervention being cost-effective at a willingness to pay threshold of £20,000 per QALY gained. Similar results were found for separate cohorts of men and women. The results were robust to sensitivity analyses, provided that the blood pressure lowering effect of self-management was maintained for more than a year.Conclusion: Self-management of blood pressure in {\textquoteleft}high risk{\textquoteright} people with poorly controlled hypertension not only reduces blood pressure, compared with usual care, but also represents a cost-effective use of health care resources.",
keywords = "Hypertension, self-management, cost-effectiveness, decision model, decision analysis",
author = "Maria Penaloza and Sue Jowett and Jonathan Mant and Claire Schwartz and Emma Bray and Mohammad Haque and Hobbs, {F. D. Richard} and Paul Little and Stirling Bryan and Bryan Williams and McManus, {Richard J}",
year = "2016",
month = jun,
doi = "10.1177/2047487315618784",
language = "English",
volume = "23",
pages = "902--12",
journal = "European journal of preventive cardiology",
issn = "2047-4873",
publisher = "SAGE Publications",
number = "9",

}

RIS

TY - JOUR

T1 - Cost-effectiveness of self-management of blood pressure in hypertensive patients over 70 years with sub-optimal control and established cardiovascular disease or additional CV risk diseases (TASMIN-SR)

AU - Penaloza, Maria

AU - Jowett, Sue

AU - Mant, Jonathan

AU - Schwartz, Claire

AU - Bray, Emma

AU - Haque, Mohammad

AU - Hobbs, F. D. Richard

AU - Little, Paul

AU - Bryan, Stirling

AU - Williams, Bryan

AU - McManus, Richard J

PY - 2016/6

Y1 - 2016/6

N2 - Background: A previous economic analysis of self-management, that is, self-monitoring with self-titration of antihypertensive mediation evaluated cost-effectiveness among patients with uncomplicated hypertension. This study considered cost-effectiveness of self-management in those with raised blood pressure plus diabetes, chronic kidney disease (CKD) and/or previous cardiovascular disease.Design and methods: A Markov model-based economic evaluation was undertaken to estimate the long-term cost-effectiveness of self-management of blood pressure in a cohort of 70-year old ‘high risk’ patients, compared with usual care. The model used the results of the TASMIN-SR trial. A cost-utility analysis was undertaken from a UK health and social care perspective, taking into account lifetime costs of treatment, cardiovascular events and quality adjusted life years (QALYs). A sub-group analysis ran the model separately for men and women. Deterministic sensitivity analyses examined the effect of different time horizons and reduced effectiveness of self-management.Results: Base-case results indicated that self-management was cost-effective compared with usual care, resulting in more QALYs (0.21) and cost savings (-£830) per patient. There was a 99% chance of the intervention being cost-effective at a willingness to pay threshold of £20,000 per QALY gained. Similar results were found for separate cohorts of men and women. The results were robust to sensitivity analyses, provided that the blood pressure lowering effect of self-management was maintained for more than a year.Conclusion: Self-management of blood pressure in ‘high risk’ people with poorly controlled hypertension not only reduces blood pressure, compared with usual care, but also represents a cost-effective use of health care resources.

AB - Background: A previous economic analysis of self-management, that is, self-monitoring with self-titration of antihypertensive mediation evaluated cost-effectiveness among patients with uncomplicated hypertension. This study considered cost-effectiveness of self-management in those with raised blood pressure plus diabetes, chronic kidney disease (CKD) and/or previous cardiovascular disease.Design and methods: A Markov model-based economic evaluation was undertaken to estimate the long-term cost-effectiveness of self-management of blood pressure in a cohort of 70-year old ‘high risk’ patients, compared with usual care. The model used the results of the TASMIN-SR trial. A cost-utility analysis was undertaken from a UK health and social care perspective, taking into account lifetime costs of treatment, cardiovascular events and quality adjusted life years (QALYs). A sub-group analysis ran the model separately for men and women. Deterministic sensitivity analyses examined the effect of different time horizons and reduced effectiveness of self-management.Results: Base-case results indicated that self-management was cost-effective compared with usual care, resulting in more QALYs (0.21) and cost savings (-£830) per patient. There was a 99% chance of the intervention being cost-effective at a willingness to pay threshold of £20,000 per QALY gained. Similar results were found for separate cohorts of men and women. The results were robust to sensitivity analyses, provided that the blood pressure lowering effect of self-management was maintained for more than a year.Conclusion: Self-management of blood pressure in ‘high risk’ people with poorly controlled hypertension not only reduces blood pressure, compared with usual care, but also represents a cost-effective use of health care resources.

KW - Hypertension

KW - self-management

KW - cost-effectiveness

KW - decision model

KW - decision analysis

U2 - 10.1177/2047487315618784

DO - 10.1177/2047487315618784

M3 - Article

VL - 23

SP - 902

EP - 912

JO - European journal of preventive cardiology

JF - European journal of preventive cardiology

SN - 2047-4873

IS - 9

ER -