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

Billingsley Kaambwa, Stirling Bryan, Sue Jowett, Jonathan Mant, Emma Bray, F Hobbs, Roger Holder, Miren Jones, Paul Little, Bryan Williams, Richard McManus

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    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 costeffectiveness 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 languageEnglish
    Pages (from-to)1517-1530
    Number of pages14
    JournalEuropean Journal of Preventive Cardiology
    Volume21
    Issue number12
    DOIs
    Publication statusPublished - 2014

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  • Cite this

    Kaambwa, B., Bryan, S., Jowett, S., Mant, J., Bray, E., Hobbs, F., Holder, R., Jones, M., Little, P., Williams, B., & McManus, R. (2014). Telemonitoring and self-management in the control of hypertension (TASMINH2): a cost-effectiveness analysis. European Journal of Preventive Cardiology, 21(12), 1517-1530. https://doi.org/10.1177/2047487313501886