title: Telemonitoring and self-management in the control of hypertension (TASMINH2): a cost-effectiveness analysis.
abstract: OBJECTIVE
  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.
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Flinders Health Economics Group, School of Medicine, Flinders University, Repatriation General Hospital, Daw Park, Australia.
authors.forename: Billingsley
authors.initials: B
authors.lastname: Kaambwa
authors.affiliation: Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute and School of Population and Public Health, University of British Columbia, Vancouver, Canada Stirling.Bryan@ubc.ca.
authors.forename: Stirling
authors.initials: S
authors.lastname: Bryan
authors.affiliation: Health Economics Unit, Division of Health and Population Sciences, University of Birmingham, UK.
authors.forename: Sue
authors.initials: S
authors.lastname: Jowett
authors.affiliation: Primary Care Unit, Institute of Public Health, University of Cambridge, UK.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Mant
authors.affiliation: Primary Care Clinical Sciences, NIHR School for Primary Care Research, University of Birmingham, UK.
authors.forename: Emma P
authors.initials: EP
authors.lastname: Bray
authors.affiliation: Primary Care Health Sciences, NIHR School for Primary Care Research, University of Oxford, UK.
authors.forename: F D Richard
authors.initials: FD
authors.lastname: Hobbs
authors.affiliation: Primary Care Clinical Sciences, NIHR School for Primary Care Research, University of Birmingham, UK.
authors.forename: Roger
authors.initials: R
authors.lastname: Holder
authors.affiliation: Primary Care Clinical Sciences, NIHR School for Primary Care Research, University of Birmingham, UK.
authors.forename: Miren I
authors.initials: MI
authors.lastname: Jones
authors.affiliation: School of Medicine, University of Southampton, UK.
authors.forename: Paul
authors.initials: P
authors.lastname: Little
authors.affiliation: Institute of Cardiovascular Sciences, University College London, UK.
authors.forename: Bryan
authors.initials: B
authors.lastname: Williams
authors.affiliation: Primary Care Health Sciences, NIHR School for Primary Care Research, University of Oxford, UK richard.mcmanus@phc.ox.ac.uk.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: McManus
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000191:economics* / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects*; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D005260:Female; D017048:Health Care Costs; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics* / Q000503:physiopathology; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D018803:Models, Economic; D011446:Prospective Studies; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D012648:Self Care / Q000191:economics*; D017216:Telemedicine / Q000191:economics* / Q000379:methods; D013997:Time Factors; D016896:Treatment Outcome; D006113:United Kingdom
chemical_list: D000959:Antihypertensive Agents
keywords: Hypertension; cost-effectiveness; self-management; telemonitoring