Self-monitoring and management of blood pressure in patients with stroke or TIA: An economic evaluation of TEST-BP, a randomised controlled trial

Kim, Lois G., Wilson, Edward C. F. ORCID: https://orcid.org/0000-0002-8369-1577, Davison, William J., Clark, Allan B. ORCID: https://orcid.org/0000-0003-2965-8941, Myint, Phyo K. and Potter, John F. (2020) Self-monitoring and management of blood pressure in patients with stroke or TIA: An economic evaluation of TEST-BP, a randomised controlled trial. PharmacoEconomics - Open, 4. 511–517. ISSN 2509-4262

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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: Our objective was to estimate the cost effectiveness of treatment as usual (TAU) versus (1) self-monitoring of BP (S-MON) and (2) self-monitoring and guided self-management of anti-hypertensive medication (S-MAN). Methods: This was a within-trial economic evaluation of a randomised controlled trial estimating the incremental cost per 1 mmHg BP reduction and per quality-adjusted life-year (QALY) gained over a 6-month time horizon from the perspective of the UK National Health Service (NHS). Results: Data were evaluable for 140 participants. Costs per patient were £473, £853 and £1035; mean reduction in systolic BP (SBP) was 3.6, 6.7 and 6.1 mmHg, and QALYs accrued were 0.427, 0.422 and 0.423 for TAU, S-MON and S-MAN, respectively. No statistically significant differences in incremental costs or outcomes were detected. On average, S-MAN was dominated or extended dominated. The incremental cost per 1 mmHg BP reduction from S-MON versus TAU was £137. Conclusion: On average, S-MAN is an inefficient intervention. S-MON may be cost effective, depending on the willingness to pay for a 1 mmHg BP reduction, although it yielded fewer QALYs over the within-trial time horizon. Decision modelling is required to explore the longer-term costs and outcomes.

Item Type: Article
Uncontrolled Keywords: cost-effectiveness,hypertension,prevention,reduction,pharmacology (medical),health policy,pharmacology ,/dk/atira/pure/subjectarea/asjc/2700/2736
Faculty \ School: Faculty of Medicine and Health Sciences > Norwich Medical School
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Depositing User: LivePure Connector
Date Deposited: 24 Jan 2020 03:27
Last Modified: 22 Oct 2022 05:44
URI: https://ueaeprints.uea.ac.uk/id/eprint/73770
DOI: 10.1007/s41669-020-00196-w

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