title: Cost-effectiveness of self-management of blood pressure in hypertensive patients over 70 years with suboptimal control and established cardiovascular disease or additional cardiovascular risk diseases (TASMIN-SR).
abstract: A previous economic analysis of self-management, that is, self-monitoring with self-titration of antihypertensive medication evaluated cost-effectiveness among patients with uncomplicated hypertension. This study considered cost-effectiveness of self-management in those with raised blood pressure plus diabetes, chronic kidney disease and/or previous cardiovascular disease.
  
  
  
  A Markov model-based economic evaluation was undertaken to estimate the long-term cost-effectiveness of self-management of blood pressure in a cohort of 70-year-old 'high risk' patients, compared with usual care. The model used the results of the TASMIN-SR trial. A cost-utility analysis was undertaken from a UK health and social care perspective, taking into account lifetime costs of treatment, cardiovascular events and quality adjusted life years. A subgroup analysis ran the model separately for men and women. Deterministic sensitivity analyses examined the effect of different time horizons and reduced effectiveness of self-management.
  
  
  
  Base-case results indicated that self-management was cost-effective compared with usual care, resulting in more quality adjusted life years (0.21) and cost savings (-£830) per patient. There was a 99% chance of the intervention being cost-effective at a willingness to pay threshold of £20,000 per quality adjusted life year gained. Similar results were found for separate cohorts of men and women. The results were robust to sensitivity analyses, provided that the blood pressure lowering effect of self-management was maintained for more than a year.
  
  
  
  Self-management of blood pressure in high-risk people with poorly controlled hypertension not only reduces blood pressure, compared with usual care, but also represents a cost-effective use of healthcare resources.
authors.affiliation: Health Economics Unit, University of Birmingham, UK.
authors.forename: Maria Cristina
authors.initials: MC
authors.lastname: Penaloza-Ramos
authors.affiliation: Health Economics Unit, University of Birmingham, UK s.jowett@bham.ac.uk.
authors.forename: Sue
authors.initials: S
authors.lastname: Jowett
authors.affiliation: Primary Care Unit, University of Cambridge, UK.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Mant
authors.affiliation: Nuffield Department of Primary Care Health Sciences, University of Oxford, UK.
authors.forename: Claire
authors.initials: C
authors.lastname: Schwartz
authors.affiliation: School of Psychology, University of Central Lancashire, UK.
authors.forename: Emma P
authors.initials: EP
authors.lastname: Bray
authors.affiliation: Primary Care Clinical Sciences, University of Birmingham, UK.
authors.forename: M
authors.initials: M
authors.lastname: Sayeed Haque
authors.affiliation: Nuffield Department of Primary Care Health Sciences, University of Oxford, UK.
authors.forename: F D
authors.initials: FD
authors.lastname: Richard Hobbs
authors.affiliation: School of Medicine, University of Southampton, UK.
authors.forename: Paul
authors.initials: P
authors.lastname: Little
authors.affiliation: Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Canada School of Population and Public Health, University of British Columbia, Canada.
authors.forename: Stirling
authors.initials: S
authors.lastname: Bryan
authors.affiliation: Institute of Cardiovascular Sciences, University College London, UK.
authors.forename: Bryan
authors.initials: B
authors.lastname: Williams
authors.affiliation: Nuffield Department of Primary Care Health Sciences, University of Oxford, UK.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: McManus
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects*; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D016527:Drug Costs; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics* / Q000503:physiopathology; D008297:Male; D008390:Markov Chains; D018803:Models, Economic; D017064:Process Assessment, Health Care / Q000191:economics*; D019057:Quality-Adjusted Life Years; D012648:Self Care / Q000191:economics*; D013997:Time Factors; D016896:Treatment Outcome; D006113:United Kingdom
chemical_list: D000959:Antihypertensive Agents
keywords: Hypertension; cost-effectiveness; decision analysis; decision model; self-management