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

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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.

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                Author and article information

                Journal
                Hypertension
                Hypertension
                HYP
                Hypertension (Dallas, Tex. : 1979)
                Lippincott, Williams & Wilkins
                0194-911X
                1524-4563
                June 2019
                15 April 2019
                : 73
                : 6
                : 1231-1239
                Affiliations
                [1 ]From the Institute of Applied Health Research, University of Birmingham, United Kingdom (M.M., S.J., S. Greenfield, J.H.)
                [2 ]Nuffield Department of Primary Care Health Sciences, University of Oxford, United Kingdom (A.N., M.F., F.D.R.H., R.J.M.)
                [3 ]Translational Health Sciences, University of Bristol, United Kingdom (S. Grant)
                [4 ]Department of Public Health and Primary Care, University of Cambridge, United Kingdom (J.M.).
                Author notes
                Correspondence to Sue Jowett, Health Economics Unit, Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham B15 2TT, United Kingdom. Email s.jowett@ 123456bham.ac.uk
                Article
                00014
                10.1161/HYPERTENSIONAHA.118.12415
                6510405
                31067190
                d3ef9a4a-e78f-400f-ac19-5a637d4106f6
                © 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.

                History
                : 21 November 2018
                : 3 December 2018
                : 11 March 2019
                Categories
                10110
                10111
                Original Articles
                Blood Pressure Monitoring
                Custom metadata
                TRUE

                blood pressure,cost-benefit analysis,probability,self-management

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