title: Cost-effectiveness of secondary screening modalities for hypertension.
abstract: BACKGROUND
  Clinic-based blood pressure (CBP) has been the default approach for the diagnosis of hypertension, but patients may be misclassified because of masked hypertension (false negative) or 'white coat' hypertension (false positive). The incorporation of other diagnostic modalities, such as home blood pressure monitoring (HBPM) and ambulatory blood pressure monitoring (ABPM), holds promise to improve diagnostic accuracy and subsequent treatment decisions.
  
  
  METHODS
  We reviewed the literature on the costs and cost-effectiveness of adding HBPM and ABPM to routine blood pressure screening in adults. We excluded letters, editorials, and studies of pregnant and/or pre-eclamptic patients, children, and patients with specific conditions (e.g. diabetes).
  
  
  RESULTS
  We identified 14 original, English language studies that included cost outcomes and compared two or more modalities. ABPM was found to be cost saving for diagnostic confirmation following an elevated CBP in six studies. Three of four studies found that adding HBPM to an elevated CBP was also cost-effective.
  
  
  CONCLUSIONS
  Existing evidence supports the cost-effectiveness of incorporating HBPM or ABPM after an initial CBP-based diagnosis of hypertension. Future research should focus on their implementation in clinical practice, long-term economic values, and potential roles in identifying masked hypertension.
authors.affiliation: Department of Health Policy and Management, Columbia Mailman School of Public Health, Stony Brook University, New York, NY, USA. ycw2102@columbia.edu
authors.forename: Y Claire
authors.initials: YC
authors.lastname: Wang
authors.forename: Alisa M
authors.initials: AM
authors.lastname: Koval
authors.forename: Miyabi
authors.initials: M
authors.lastname: Nakamura
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Newman
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Schwartz
authors.forename: Patricia W
authors.initials: PW
authors.lastname: Stone
mesh_terms: D000328:Adult; D018660:Blood Pressure Monitoring, Ambulatory / Q000191:economics* / Q000379:methods; D003365:Costs and Cost Analysis; D005188:False Negative Reactions; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D006973:Hypertension / Q000191:economics* / Q000503:physiopathology; D008297:Male