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

Author

Listed:
  • Lois G. Kim

    (University of Cambridge School of Clinical Medicine
    Strangeways Research Laboratory)

  • Edward C. F. Wilson

    (University of Cambridge School of Clinical Medicine
    University of East Anglia)

  • William J. Davison

    (University of East Anglia)

  • Allan B. Clark

    (University of East Anglia)

  • Phyo K. Myint

    (University of Aberdeen)

  • John F. Potter

    (University of East Anglia)

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.

Suggested Citation

  • Lois G. Kim & Edward C. F. Wilson & William J. Davison & Allan B. Clark & Phyo K. Myint & John F. Potter, 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, Springer, vol. 4(3), pages 511-517, September.
  • Handle: RePEc:spr:pharmo:v:4:y:2020:i:3:d:10.1007_s41669-020-00196-w
    DOI: 10.1007/s41669-020-00196-w
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    Blog mentions

    As found by EconAcademics.org, the blog aggregator for Economics research:
    1. Rita Faria’s journal round-up for 14th September 2020
      by Rita Faria in The Academic Health Economists' Blog on 2020-09-14 11:00:07

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