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 language | English |
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Pages (from-to) | 1517-30 |
Number of pages | 14 |
Journal | European journal of preventive cardiology |
Volume | 21 |
Issue number | 12 |
DOIs | |
Publication status | Published - 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