Cost-effectiveness of telemonitoring and self-monitoring of blood pressure for antihypertensive titration in primary care (TASMINH4)

The use of self-monitoring of Blood Pressure (BP), with or without telemonitoring, to guide therapy decisions by physicians for patients with hypertension has been recently demonstrated to reduce BP compared with using clinic monitoring (usual care). However, both the cost-effectiveness of these strategies compared to usual care, and whether the additional benefit of telemonitoring compared with self-monitoring alone could be considered value for money, are unknown. This study assessed the cost-effectiveness of physician titration of antihypertensive medication using self-monitored BP, with or without telemonitoring, to make hypertension treatment decisions in primary care compared with usual care. A Markov patient-level simulation model was developed taking a UK Health Service/Personal Social Services perspective. The model adopted a lifetime time horizon with six month time cycles. At a willingness to pay of £20,000 per Quality Adjusted Life Year, self-monitoring plus telemonitoring was the most cost-effective strategy (£17,424 per QALY gained) compared with usual care or self-monitoring alone (posting the results to the physician). However, deterministic sensitivity analysis showed that self-monitoring alone became the most cost-effective option when changing key assumptions around long term effectiveness and time horizon. Overall, probabilistic sensitivity analysis suggested that self-monitoring regardless of transmission modality was very likely to be cost-effective compared with usual care (89% probability of cost-effectiveness at £20,000/QALY), with high uncertainty as to whether telemonitoring or self-monitoring alone was the most cost-effective option. Self-monitoring in clinical practice is cost-effective and likely to lead to reduced cardiovascular mortality and morbidity.