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

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@article{e36380fbe04c4dc0a6b6a269fecbbb24,
title = "Telemonitoring and self-management in the control of hypertension (TASMINH2): a cost-effectiveness analysis",
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.",
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",
author = "Billingsley Kaambwa and Stirling Bryan and Sue Jowett and Jonathan Mant and Bray, {Emma P} and Hobbs, {F D Richard} and Roger Holder and Jones, {Miren I} and Paul Little and Bryan Williams and McManus, {Richard J}",
note = "{\textcopyright} The European Society of Cardiology 2013 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.",
year = "2014",
month = dec,
doi = "10.1177/2047487313501886",
language = "English",
volume = "21",
pages = "1517--30",
journal = "European journal of preventive cardiology",
issn = "2047-4873",
publisher = "SAGE Publications",
number = "12",

}

RIS

TY - JOUR

T1 - Telemonitoring and self-management in the control of hypertension (TASMINH2)

T2 - a cost-effectiveness analysis

AU - Kaambwa, Billingsley

AU - Bryan, Stirling

AU - Jowett, Sue

AU - Mant, Jonathan

AU - Bray, Emma P

AU - Hobbs, F D Richard

AU - Holder, Roger

AU - Jones, Miren I

AU - Little, Paul

AU - Williams, Bryan

AU - McManus, Richard J

N1 - © The European Society of Cardiology 2013 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

PY - 2014/12

Y1 - 2014/12

N2 - 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.

AB - 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.

KW - Adult

KW - Aged

KW - Aged, 80 and over

KW - Antihypertensive Agents

KW - Blood Pressure

KW - Cost-Benefit Analysis

KW - Drug Costs

KW - Female

KW - Great Britain

KW - Health Care Costs

KW - Humans

KW - Hypertension

KW - Male

KW - Markov Chains

KW - Middle Aged

KW - Models, Economic

KW - Prospective Studies

KW - Quality of Life

KW - Quality-Adjusted Life Years

KW - Self Care

KW - Telemedicine

KW - Time Factors

KW - Treatment Outcome

U2 - 10.1177/2047487313501886

DO - 10.1177/2047487313501886

M3 - Article

C2 - 23990660

VL - 21

SP - 1517

EP - 1530

JO - European journal of preventive cardiology

JF - European journal of preventive cardiology

SN - 2047-4873

IS - 12

ER -