Telemonitoring and self-management in the control of hypertension (TASMINH2): a cost-effectiveness analysis
Telemonitoring and self-management in the control of hypertension (TASMINH2): a cost-effectiveness analysis
复制标题
DOI：
10.1177/2047487313501886
复制
发表时间：
2014-12-01
影响因子：
8.3
通讯作者：
McManus, Richard J.
中科院分区：
文献类型：
--
作者：
Kaambwa, Billingsley;Bryan, Stirling;McManus, Richard J.
目的：抗高血压药物的自我监测和自我滴定（自我管理）是一种改善血压控制的新型干预措施。然而，关于一般自我监测血压尤其是自我管理的成本效益的证据很少。本研究旨在评估高血压的自我管理是否具有成本效益。设计和方法：基于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，进行了基于队列马尔可夫模型的概率成本效益分析，推断长达 35 年。使用英国卫生服务的角度，将高血压的自我管理与常规护理在终生成本、质量调整生命年和成本效益方面进行比较。敏感性分析检查了不同时间范围的影响以及随着时间的推移自我管理的有效性降低。结果：从长远来看，与常规护理相比，男性和女性每位患者的自我管理分别延长了 0.24 和 0.12 质量调整生命年 (QALY)。由此产生的自我管理增量成本效益比为，男性每 QALY 1624 磅，女性每 QALY 4923 磅。如果每获得 QALY 的支付意愿为 20,000 英镑，则干预措施对男女都具有成本效益的可能性至少为 99%。这些结果对于围绕所做出的假设进行的敏感性分析是稳健的，前提是自我管理的效果对男性至少持续两年，对女性持续五年。结论：与常规护理相比，自我滴定抗高血压药物的自我监测和血压测量的远程监测不仅可以降低血压，而且代表了医疗保健资源的经济有效利用。
Aims: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. Design and methods: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. Results: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 pound 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 pound 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. Conclusion: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.