Kaambwa Billingsley, Bryan Stirling, Jowett Sue, Mant Jonathan, Bray Emma P, Hobbs F D Richard, Holder Roger, Jones Miren I, Little Paul, Williams Bryan, McManus Richard J
Flinders Health Economics Group, School of Medicine, Flinders University, Repatriation General Hospital, Daw Park, Australia.
Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute and School of Population and Public Health, University of British Columbia, Vancouver, Canada
Eur J Prev Cardiol. 2014 Dec;21(12):1517-30. doi: 10.1177/2047487313501886. Epub 2013 Aug 29.
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.
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.
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.
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.
抗高血压药物的自我监测和自我滴定（自我管理）是一种新型干预措施，可改善血压控制。然而，关于一般血压自我监测尤其是自我管理的成本效益，几乎没有证据。本研究旨在评估高血压自我管理是否具有成本效益。
基于队列马尔可夫模型进行概率成本效益分析，从高血压远程监测和自我管理试验（TASMINH2）收集的成本和结果数据外推至长达35年。从英国医疗服务的角度，就终身成本、质量调整生命年和成本效益方面，将高血压自我管理与常规护理进行比较。敏感性分析考察了不同时间范围以及自我管理随时间效果降低的影响。
从长期来看，与常规护理相比，自我管理对男性和女性每例患者分别多获得0.24和0.12个质量调整生命年（QALY）。自我管理的增量成本效益比男性为每QALY 1624英镑，女性为每QALY 4923英镑。在每获得一个QALY支付意愿阈值为20,000英镑的情况下，该干预措施对两性具有成本效益的可能性至少为99%。只要自我管理的效果对男性至少持续两年、对女性至少持续五年，这些结果对围绕所做假设的敏感性分析具有稳健性。
抗高血压药物的自我监测与自我滴定以及血压测量的远程监测，不仅与常规护理相比可降低血压，而且代表了医疗保健资源的成本效益使用。
