Telemonitoring and self-management in the control of hypertension (TASMINH2): a cost-effectiveness analysis

Billingsley Kaambwa, Stirling Bryan, Sue Jowett, Jonathan Mant, Emma P Bray, F D Richard Hobbs, Roger Holder, Miren I Jones, Paul Little, Bryan Williams, Richard J McManus

Research output: Contribution to journalArticlepeer-review

49 Citations (Scopus)

Abstract

AIMS: Self-monitoring and self-titration of antihypertensives (self-management) is a novel intervention which improves blood pressure control. However, little evidence exists regarding the cost-effectiveness of self-monitoring of blood pressure in general and self-management in particular. This study aimed to evaluate whether self-management of hypertension was cost-effective.

DESIGN AND METHODS: A cohort Markov model-based probabilistic cost-effectiveness analysis was undertaken extrapolating to up to 35 years from cost and outcome data collected from the telemonitoring and self-management in hypertension trial (TASMINH2). Self-management of hypertension was compared with usual care in terms of lifetime costs, quality adjusted life years and cost-effectiveness using a UK Health Service perspective. Sensitivity analyses examined the effect of different time horizons and reduced effectiveness over time from self-management.

RESULTS: In the long-term, when compared with usual care, self-management was more effective by 0.24 and 0.12 quality adjusted life years (QALYs) gained per patient for men and women, respectively. The resultant incremental cost-effectiveness ratio for self-management was £1624 per QALY for men and £4923 per QALY for women. There was at least a 99% chance of the intervention being cost-effective for both sexes at a willingness to pay threshold of £20,000 per QALY gained. These results were robust to sensitivity analyses around the assumptions made, provided that the effects of self-management lasted at least two years for men and five years for women.

CONCLUSION: Self-monitoring with self-titration of antihypertensives and telemonitoring of blood pressure measurements not only reduces blood pressure, compared with usual care, but also represents a cost-effective use of health care resources.

Original languageEnglish
Pages (from-to)1517-30
Number of pages14
JournalEuropean journal of preventive cardiology
Volume21
Issue number12
DOIs
Publication statusPublished - Dec 2014

Keywords

  • Adult
  • Aged
  • Aged, 80 and over
  • Antihypertensive Agents
  • Blood Pressure
  • Cost-Benefit Analysis
  • Drug Costs
  • Female
  • Great Britain
  • Health Care Costs
  • Humans
  • Hypertension
  • Male
  • Markov Chains
  • Middle Aged
  • Models, Economic
  • Prospective Studies
  • Quality of Life
  • Quality-Adjusted Life Years
  • Self Care
  • Telemedicine
  • Time Factors
  • Treatment Outcome

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