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Cost-Effectiveness of Telemonitoring and Self-Monitoring of Blood Pressure for Antihypertensive Titration in Primary Care (TASMINH4)

Monahan, M., Jowett, S., Nickless, A., Franssen, M., Grant, Sabrina ORCID: https://orcid.org/0000-0003-0148-9103, Greenfield, S., Hobbs, F.D.R., Hodgkinson, J., Mant, J. and J., R. (2019) Cost-Effectiveness of Telemonitoring and Self-Monitoring of Blood Pressure for Antihypertensive Titration in Primary Care (TASMINH4). Hypertension, 73 (6). pp. 1231-1239. ISSN Print: 0194-911X Online: 1524-4563

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Abstract

The use of self-monitoring of blood pressure, with or without telemonitoring, to guide therapy decisions by physicians for patients with hypertension has been recently demonstrated to reduce blood pressure compared with using clinic monitoring (usual care). However, both the cost-effectiveness of these strategies compared with 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 blood pressure, 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 6-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 quality-adjusted life year 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 likely to be cost-effective compared with usual care (89% probability of cost-effectiveness at £20 000/quality-adjusted life year), 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.

Item Type: Article
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© 2019 The Authors. Hypertension is published on behalf of the American Heart Association, Inc., by Wolters Kluwer Health, Inc. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution, and reproduction in any medium, provided that the original work is properly cited.

The full-text of the online published article can be accessed via the official URL.

Uncontrolled Keywords: probability, self-management, blood pressure, cost-benefit analysis
Divisions: Divisions (2019 onwards) > College of Health, Life and Environmental Sciences > School of Nursing and Midwifery
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Copyright Info: Open access article
Depositing User: Dr Sabrina Grant
Date Deposited: 17 Oct 2019 14:36
Last Modified: 17 Oct 2019 14:36
URI: https://eprints.worc.ac.uk/id/eprint/8760

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