Cost analysis of ambulatory blood pressure monitoring in initiating antihypertensive drug treatment in Australian general practice.
OBJECTIVE
To compare the cost of ambulatory blood pressure monitoring (ABPM) with the putative savings made through treatment avoided by identification and non-treatment of those with "white coat" hypertension.


METHODS
A cost analysis based on a model of four alternative strategies (no ABPM, yearly, two-yearly, or three-yearly monitoring) over a seven-year period applied to a case series from Australian general practice.


METHODS
62 patients newly diagnosed by their GPs as having hypertension and requiring drug treatment.


METHODS
The proportion of patients shown to not need treatment. The discounted costs to the Pharmaceutical Benefits Scheme, Medical Benefits Scheme and patients.


RESULTS
16 of 62 patients (26%; 95% CI, 15%-37%) were normotensive on ABPM and did not require treatment. All monitoring strategies are more expensive in the first year, but the initial costs are offset by year 3 and the monitoring strategies are cost saving thereafter. Sensitivity analysis shows that this result holds across a range of costs of pharmacotherapy and proportion of patients with white coat hypertension.


CONCLUSIONS
The additional costs of 24-hour ABPM in the first year are offset by savings associated with patients with white coat hypertension who would otherwise have been treated.
Ewald
Ben
B
Central Australian Division of General Practice, Alice Springs, NT. bewald@cceb.newcastle.edu.au
Pekarsky
Brita
B
D000959:Antihypertensive Agents / Q000191:economics* / Q000627:therapeutic use; D001315:Australia; D018660:Blood Pressure Monitoring, Ambulatory / Q000191:economics*; D003365:Costs and Cost Analysis; D005194:Family Practice / Q000191:economics; D005260:Female; D017048:Health Care Costs; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy / Q000191:economics*; D008297:Male; D018803:Models, Economic
D000959:Antihypertensive Agents