Almazov National Medical Research Center, Ministry of Health of the Russian Federation, Saint-Petersburg, Russian Federation.
Institute of Translational Medicine, ITMO University, Saint-Petersburg, Russian Federation.
Blood Press. 2021 Feb;30(1):20-30. doi: 10.1080/08037051.2020.1813015. Epub 2020 Sep 21.
Blood pressure telemonitoring and remote counselling (BPTM) improves blood pressure (BP) control in patients with hypertension (HTN). Studies assessing the efficacy of BPTM from a value-based perspective are lacking. We investigated whether BPTM fits all principles of the value-based approach (clinical and economic effectiveness, improvement in patient-reported outcome/experience measures (PROM/PREM)).
Two hundred and forty ambulatory patients with uncontrolled HTN were randomised in a 2: 1 manner to BPTM ( = 160, mean age 47 y.o.) and usual care (UC, = 80; 49 y.o.) with baseline and 3-month follow-up clinic visits. BPTM employed a mobile application (for patients) and a desktop version (for clinician), which allowed communication and exchange of medical data. The main outcomes were changes in office and ambulatory systolic (S) BPs, rate of BP control. The incremental cost-effectiveness ratio (ICER) and incremental cost-utility ratio (ICUR) were evaluated in economic analysis. The MOS SF-36 score was taken as a PROM, and the PEQ score was used as a PREM.
Larger decreases in office and ambulatory SBPs (-16.8 and -8.9 mm Hg, respectively; < .05) was achieved in BPTM group while the treatment intensity was equal (2.4 drugs). The ICER 11.1 EUR/-1 mm Hg 24-hour SBP/1 year was 75% effective as per willingness-to-pay threshold. BPTM improved PROM (+2.1 in mean MOS SF-36; = .04), reduced long-term mortality (+0.11 life years gained), leading to +0.49 quality-adjusted life years (QALYs) gained as compared with UC. The ICUR was 4 169.4 EUR/QALY gained. Patient-reported experience was higher in the BPTM (+10 PEQ, = .01). The UC group showed minor changes in MOS SF-36 and PEQ (+1.3; +6, respectively; n.s.).
Being cost-effective, BPTM incorporates both clinical benefits and patient-perceived value. Larger randomised studies are needed to confirm our findings.
血压远程监测和远程咨询（BPTM）可改善高血压（HTN）患者的血压（BP）控制。缺乏从基于价值的角度评估 BPTM 疗效的研究。我们研究了 BPTM 是否符合基于价值的方法的所有原则（临床和经济效果、患者报告的结果/经验测量（PROM/PREM）的改善）。
240 名未控制的 HTN 门诊患者以 2:1 的比例随机分为 BPTM 组（160 名，平均年龄 47 岁）和常规护理组（UC，80 名；49 岁），并进行基线和 3 个月的门诊随访。BPTM 使用移动应用程序（用于患者）和桌面版本（用于临床医生），允许通信和交换医疗数据。主要结局是诊室和动态收缩压（SBP）的变化，BP 控制率。在经济分析中评估了增量成本效果比（ICER）和增量成本效用比（ICUR）。MOS SF-36 评分作为 PROM，PEQ 评分作为 PREM。
BPTM 组诊室和动态 SBP 下降幅度更大（分别为-16.8 和-8.9mmHg；<0.05），而治疗强度相等（2.4 种药物）。根据意愿支付阈值，11.1 欧元/-1mmHg 24 小时 SBP/1 年的 ICER 为 75%有效。BPTM 改善了 PROM（平均 MOS SF-36 增加 2.1；=0.04），降低了长期死亡率（增加 0.11 个生命年），与 UC 相比，导致增加 0.49 个质量调整生命年（QALY）。ICUR 为 4169.4 欧元/QALY 增加。与 UC 组相比，患者报告的体验在 BPTM 组更高（PEQ 增加 10；=0.01）。UC 组的 MOS SF-36 和 PEQ 仅略有变化（分别增加 1.3；增加 6；无统计学意义）。
BPTM 具有成本效益，同时包含临床益处和患者感知价值。需要更大规模的随机研究来证实我们的发现。
