title: Cost-effectiveness of noninvasive central blood pressure monitoring in the diagnosis of hypertension.
abstract: BACKGROUND
  Central blood pressure (CBP) betters conventional clinical BP (cuff BP) in predicting cardiovascular outcomes. Noninvasive CBP monitoring has emerged as a new technology for management of hypertension. This study aimed to analyze the cost-effectiveness of noninvasive CBP compared to cuff BP monitoring for confirming a diagnosis of hypertension.
  
  
  METHODS
  Lifetime costs and quality-adjusted life years (QALYs) were estimated for CBP and cuff BP monitoring using a cohort Markov model. We applied model calibration and probabilistic sensitivity analysis on populations representative of the general population, in 10-year age brackets, from age 35 years to over 75 years of age.
  
  
  RESULTS
  The CBP strategy was more cost-effective than cuff BP for men and women across all age subgroups, with mean incremental cost-effectiveness ratios ranging from £226 to £2,750 per QALY gained. The cost-effectiveness was mainly driven by improved patient outcomes, represented by the QALY gains (0.09-0.88), at an acceptable incremental cost (£116-£371). Deterministic and probabilistic sensitivity analyses demonstrated the consistency and robustness of the cost-effectiveness of the CBP strategy.
  
  
  CONCLUSIONS
  Early evidence on the diagnostic accuracy of noninvasive CBP monitoring suggests significant improvements in the confirmation of suspected hypertension, compared to cuff BP. This paper suggests that the long-term benefits of improved diagnostic performance justify the supplementary purchase costs of new, noninvasive CBP monitors. The results highlight the potential value of CBP, and hence the value of further research to confirm the diagnostic and prognostic role of CBP for the management of hypertension.
authors.forename: Hao-Min
authors.initials: HM
authors.lastname: Cheng
authors.affiliation: The Joanna Briggs Institute, Faculty of Health Sciences, The University of Adelaide, Adelaide, Australia;
authors.forename: Alan
authors.initials: A
authors.lastname: Pearson
authors.affiliation: Department of Medicine, National Yang-Ming University, Taipei, Taiwan; Institute of Public Health, National Yang-Ming University, Taiwan to Hao-min Cheng, Shih-Hsien Sung, and Chen-Huan Chen; Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan;
authors.forename: Shih-Hsien
authors.initials: SH
authors.lastname: Sung
authors.affiliation: Department of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan;
authors.forename: Wen-Chung
authors.initials: WC
authors.lastname: Yu
authors.forename: Chen-Huan
authors.initials: CH
authors.lastname: Chen
authors.affiliation: School of Population Health and Clinical Practice, The University of Adelaide, Adelaide, Australia. jonathan.karnon@adelaide.edu.au.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Karnon
mesh_terms: D000328:Adult; D000368:Aged; D001794:Blood Pressure; D001795:Blood Pressure Determination / Q000191:economics*; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis* / Q000191:economics / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D018803:Models, Economic
keywords: blood pressure; central blood pressure; cost-effectiveness analysis; hypertension.