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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).

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Penaloza-Ramos, Maria Cristina 
Jowett, Sue 
Schwartz, Claire 
Bray, Emma P 


BACKGROUND: 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. DESIGN AND METHODS: 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. RESULTS: 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. CONCLUSION: 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.



Hypertension, cost-effectiveness, decision analysis, decision model, self-management, Age Factors, Aged, Aged, 80 and over, Antihypertensive Agents, Blood Pressure, Cost-Benefit Analysis, Decision Support Techniques, Drug Costs, Female, Humans, Hypertension, Male, Markov Chains, Models, Economic, Process Assessment, Health Care, Quality-Adjusted Life Years, Self Care, Time Factors, Treatment Outcome, United Kingdom

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Eur J Prev Cardiol

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Oxford University Press (OUP)
This paper presents independent research funded by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research Programme (Grant Reference Number RP-PG 0606-1153) and by the NIHR National School of Primary Care Research (NSPCR 16). The views expressed in this paper are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health. Service support costs were administered through the Primary Care Research Network and collaborating Comprehensive Local Research Networks. Prof McManus was supported by NIHR Career Development and Professional Fellowships, Professors Hobbs, Little and Williams are NIHR senior investigators. Professor McManus and Hobbs receive support from the NIHR CLAHRC Oxford. Professor Hobbs also receives support from the NIHR School for Primary Care Research and the NIHR Oxford BRC.