title: Telemonitoring-based service redesign for the management of uncontrolled hypertension (HITS): cost and cost-effectiveness analysis of a randomised controlled trial.
abstract: OBJECTIVE
  To compare the costs and cost-effectiveness of managing patients with uncontrolled blood pressure (BP) using telemonitoring versus usual care from the perspective of the National Health Service (NHS).
  
  
  METHODS
  Within trial post hoc economic evaluation of data from a pragmatic randomised controlled trial using an intention-to-treat approach.
  
  
  METHODS
  20 socioeconomically diverse general practices in Lothian, Scotland.
  
  
  METHODS
  401 primary care patients aged 29-95 with uncontrolled daytime ambulatory blood pressure (ABP) (≥135/85, but <210/135 mm Hg).
  
  
  METHODS
  Participants were centrally randomised to 6 months of a telemonitoring service comprising of self-monitoring of BP transmitted to a secure website for review by the attending nurse/doctor and patient, with optional automated patient decision-support by text/email (n=200) or usual care (n-201). Randomisation was undertaken with minimisation for age, sex, family practice, use of three or more hypertension drugs and self-monitoring history.
  
  
  METHODS
  Mean difference in total NHS costs between trial arms and blinded assessment of mean cost per 1 mm Hg systolic BP point reduced.
  
  
  RESULTS
  Home telemonitoring of BP costs significantly more than usual care (mean difference per patient £115.32 (95% CI £83.49 to £146.63; p<0.001)). Increased costs were due to telemonitoring service costs, patient training and additional general practitioner and nurse consultations. The mean cost of systolic BP reduction was £25.56/mm Hg (95% CI £16.06 to £46.89) per patient.
  
  
  CONCLUSIONS
  Over the 6-month trial period, supported telemonitoring was more effective at reducing BP than usual care but also more expensive. If clinical gains are maintained, these additional costs would be very likely to be compensated for by reductions in the cost of future cardiovascular events. Longer-term modelling of costs and outcomes is required to fully examine the cost-effectiveness implications.
  
  
  BACKGROUND
  International Standard Randomised Controlled Trials, number ISRCTN72614272.
authors.affiliation: Edinburgh Clinical Trials Unit, University of Edinburgh, Western General Hospital, Edinburgh, Midlothian, UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Stoddart
authors.forename: Janet
authors.initials: J
authors.lastname: Hanley
authors.forename: Sarah
authors.initials: S
authors.lastname: Wild
authors.forename: Claudia
authors.initials: C
authors.lastname: Pagliari
authors.forename: Mary
authors.initials: M
authors.lastname: Paterson
authors.forename: Steff
authors.initials: S
authors.lastname: Lewis
authors.forename: Aziz
authors.initials: A
authors.lastname: Sheikh
authors.forename: Ashma
authors.initials: A
authors.lastname: Krishan
authors.forename: Paul
authors.initials: P
authors.lastname: Padfield
authors.forename: Brian
authors.initials: B
authors.lastname: McKinstry
keywords: Health Economics; Health Services Administration & Management