Self-Monitoring and Management of Blood Pressure in Patients with Stroke or TIA: An Economic Evaluation of TEST-BP, A Randomised Controlled Trial

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Abstract

Background: Prevention of secondary stroke following initial ictus is an important focus of after-stroke care. Blood pressure (BP) is a key risk factor so usual care following stroke or transient ischaemic attack includes regular BP checks and monitoring of anti-hypertensive medication. This is traditionally carried out in primary care, but the evidence supporting self-monitoring and self-guided management of BP in the general population with hypertension is growing.
Objective: To estimate the cost-effectiveness of treatment as usual (TAU) vs (1) self-monitoring of BP (S-MON), and (2) self-monitoring and guided self-management of antihypertensive medication (S-MAN).
Methods: Within-trial economic evaluation of a randomised controlled trial estimating the incremental cost per 1mmHg reduction in BP and per QALY gained over a six month time horizon from the perspective of the UK NHS.
Results: Data were evaluable on 140 participants. Costs per patient were £473, £853 and £1035; mean reduction in SBP was 3.6, 6.7 and 6.1mmHg, and QALYs accrued were 0.427, 0.422 and 0.423 for TAU, S-MON and S-MAN respectively. There were no statistically significant differences in incremental costs or outcomes detected. On average S-MAN was dominated or extended dominated. The incremental cost per mmHg BP reduction from S-MON vs TAU is £137.
Conclusion: On average S-MAN is an inefficient intervention. S-MON may be cost-effective, depending on the willingness to pay for a mmHg reduction in blood pressure, although it yielded fewer QALYs over the within-trial time horizon. Decision modelling is required to explore the longer-term costs and outcomes.
Original languageEnglish
Pages (from-to)511–517
Number of pages7
JournalPharmacoEconomics - Open
Volume4
Early online date13 Feb 2020
DOIs
Publication statusPublished - Sep 2020

Keywords

  • COST-EFFECTIVENESS
  • HYPERTENSION
  • PREVENTION
  • REDUCTION

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