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Eur J Prev Cardiol. 2014 Dec;21(12):1517-30. doi: 10.1177/2047487313501886. Epub 2013 Aug 29.

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

Author information

1
Flinders Health Economics Group, School of Medicine, Flinders University, Repatriation General Hospital, Daw Park, Australia.
2
Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute and School of Population and Public Health, University of British Columbia, Vancouver, Canada Stirling.Bryan@ubc.ca.
3
Health Economics Unit, Division of Health and Population Sciences, University of Birmingham, UK.
4
Primary Care Unit, Institute of Public Health, University of Cambridge, UK.
5
Primary Care Clinical Sciences, NIHR School for Primary Care Research, University of Birmingham, UK.
6
Primary Care Health Sciences, NIHR School for Primary Care Research, University of Oxford, UK.
7
School of Medicine, University of Southampton, UK.
8
Institute of Cardiovascular Sciences, University College London, UK.
9
Primary Care Health Sciences, NIHR School for Primary Care Research, University of Oxford, UK richard.mcmanus@phc.ox.ac.uk.

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:

Hypertension; cost-effectiveness; self-management; telemonitoring

PMID:
23990660
DOI:
10.1177/2047487313501886
[Indexed for MEDLINE]

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