Telemonitoring-based service redesign for the management of uncontrolled hypertension (HITS): cost and cost-effectiveness analysis of a randomised controlled trial
Key result
Home telemonitoring of blood pressure cost significantly more than usual care (mean difference £115.32; 95% CI £83.49-£146.63; p<0.001), with a mean cost of £25.56 per 1 mm Hg systolic BP reduction.
Why the study?
Does a 6-month telemonitoring service improve cost-effectiveness in primary care patients with uncontrolled hypertension compared to usual care?
Population
401 primary care patients aged 29-95 with uncontrolled daytime ambulatory blood pressure across 20 general…
Comparison
6 months of a telemonitoring service comprising… vs Usual care.
Design
RCT, Centrally randomised with minimisation for age, sex, family practice, use…
Follow-up
6 months
Authors
Discussion
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Implication
Incurs higher short-term costs than usual care; leaves open overall cost-effectiveness pending long-term modeling.
Study Design
Type
RCT (n=401)
Blinding
Blinded assessment
Randomization
Minimisation
Multicenter
Yes
Structured PICO
Does a 6-month telemonitoring service improve cost-effectiveness in primary care patients with uncontrolled hypertension compared to usual care?
P
Population
401 primary care patients aged 29-95 with uncontrolled daytime ambulatory blood pressure (≥135/85, but <210/135 mm Hg) across 20 general practices in Lothian, Scotland.
I
Intervention
6 months of a telemonitoring service comprising self-monitoring of BP transmitted to a secure website for review by attending nurse/doctor and patient, with optional automated patient decision-support by text/email.
C
Comparator
Usual care.
O
Outcome
Mean difference in total NHS costs between trial arms and blinded assessment of mean cost per 1 mm Hg systolic BP point reduced.
Main Result
Effect estimate: Mean difference £115.32 (95% CI £83.49 to £146.63)
p-value: p=<0.001
Telemonitoring for uncontrolled hypertension is more effective at reducing blood pressure than usual care but incurs higher short-term costs, requiring long-term modeling to determine overall cost-effectiveness.
Limitations
- Longer-term modelling of costs and outcomes is required to fully examine the cost-effectiveness implications.
Cite This Study
Stoddart et al. (2013) conducted an RCT in Uncontrolled hypertension (n=401). Telemonitoring service with self-monitoring of BP vs. Usual care was evaluated on Mean difference in total NHS costs between trial arms (Mean difference £115.32, 95% CI £83.49 to £146.63, p=<0.001). Home telemonitoring of blood pressure cost significantly more than usual care (mean difference £115.32; 95% CI £83.49-£146.63; p<0.001), with a mean cost of £25.56 per 1 mm Hg systolic BP reduction.