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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 publication

DOI

10.1177/2047487313501886

Type

Journal article

Journal

Eur J Prev Cardiol

Publication Date

12/2014

Volume

21

Pages

1517 - 1530

Keywords

Hypertension, cost-effectiveness, self-management, telemonitoring, Adult, Aged, Aged, 80 and over, Antihypertensive Agents, Blood Pressure, Cost-Benefit Analysis, Drug Costs, Female, 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, United Kingdom