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Cited by 95Blood Pressure and Hypertension StudiesHealth Systems, Economic Evaluations, Quality of LifeTelemedicine and Telehealth Implementation

Cost-Effectiveness of Telemonitoring and Self-Monitoring of Blood Pressure for Antihypertensive Titration in Primary Care (TASMINH4)

Open access
Monahan, Mark, Jowett, Sue, Nickless, Alecia, Franssen, Marloes, Grant, Sabrina, Greenfield, Sheila, Hobbs, F. D. Richard, Hodgkinson, James +2 more·2019·Hypertension
DOI 10.1161/hypertensionaha.118.12415PMC PMC6510405
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Abstract

The use of self-monitoring of blood pressure, with or without telemonitoring, to guide therapy decisions by physicians for patients with hypertension has been recently demonstrated to reduce blood pressure compared with using clinic monitoring (usual care). However, both the cost-effectiveness of these strategies compared with usual care, and whether the additional benefit of telemonitoring compared with self-monitoring alone could be considered value for money, are unknown. This study assessed the cost-effectiveness of physician titration of antihypertensive medication using self-monitored blood pressure, with or without telemonitoring, to make hypertension treatment decisions in primary care compared with usual care. A Markov patient-level simulation model was developed taking a UK Health Service/Personal Social Services perspective. The model adopted a lifetime time horizon with 6-month time cycles. At a willingness to pay of £20 000 per quality-adjusted life year, self-monitoring plus telemonitoring was the most cost-effective strategy (£17 424 per quality-adjusted life year gained) compared with usual care or self-monitoring alone (posting the results to the physician). However, deterministic sensitivity analysis showed that self-monitoring alone became the most cost-effective option when changing key assumptions around long-term effectiveness and time horizon. Overall, probabilistic sensitivity analysis suggested that self-monitoring regardless of transmission modality was likely to be cost-effective compared with usual care (89% probability of cost-effectiveness at £20 000/quality-adjusted life year), with high uncertainty as to whether telemonitoring or self-monitoring alone was the most cost-effective option. Self-monitoring in clinical practice is cost-effective and likely to lead to reduced cardiovascular mortality and morbidity.

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  • Data review is essential in RPM-HTN programs to facilitate successful home-based monitoring, aid patients in managing hypertension, administer antihypertensive medications, detect masked hypertension, and help avoid emergencies that could escalate to higher-acuity care.

    “While meticulous, this process is essential in RPM-HTN programs to facilitate successful home-based monitoring, aid patients in managing hypertension, administer antihypertensive medications, detect masked hypertension, and help avoid emergencies that could escalate to higher-acuity care.24–27”

    From Program cost and return on investment analysis of remote patient monitoring for hypertension management in the cardiology department of a large healthcare system (2026) · cites this paper as [26]

    The Methods, under “Model Comparators and Costs” (page not provided), describe home BP monitoring, GP review of readings to guide antihypertensive treatment, and warnings for very high or low readings. The paper does not establish that data review is essential to RPM-HTN programs, detects masked hypertension, or prevents emergencies requiring higher-acuity care. (LLM, conf=0.88)

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  1. [16]National Institute for Health and Clinical Excellence Clopidogrel and Modified-Release Dipyridamole for the Prevention of Occlusive Vascular Events: Review of NICE Technology Appraisal Guidance 90 2010 London, United Kingdom NICE
  2. [19]National Institute for Health and Care Excellence Guide to the Methods of Technology Appraisal 2013 London, United Kingdom NICE 27905712
  3. [22]Joint Formulary Committee British National Formulary 2017 73rd ed London, United Kingdom BMJ Group and Pharmaceutical Press

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Authors
Monahan, M., Jowett, S., Nickless, A., Franssen, M., Grant, S., Greenfield, S., Hobbs, F. D. R., Hodgkinson, J., Mant, J., & McManus, R. J.
Affiliations
  • University of Birmingham (GB)
  • University of Cambridge (GB)
  • University of Oxford (GB)
  • University of Bristol (GB)
  • Nuffield Department of Primary Care Health Sciences, University of Oxford, United Kingdom (A.N., M.F., F.D.R.H., R.J.M.)
Corresponding author
Jowett, Sue
ORCID
Venue
Hypertension
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2019-06
Volume
73
Issue
6
Pages
1231-1239
ISSN
  • 0194-911X (ISSN-L)
  • 1524-4563
DOI
10.1161/hypertensionaha.118.12415
PMC
PMC6510405
OpenAlex
W2936131459
Cited by
95
References
31
Citations by year
2026: 5 · 2025: 11 · 2024: 13 · 2023: 14 · 2022: 10 · 2021: 24 · 2020: 13 · 2019: 5
FWCI
9.39
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • Hypertension (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Explore Bristol Research (publishedVersion, cc-by)
  • Worcester Research and Publications (University of Worcester) (submittedVersion)
  • University of Birmingham Research Portal (University of Birmingham) (submittedVersion, cc-by)
  • Bristol Research (University of Bristol) (submittedVersion, cc-by)
  • Apollo (University of Cambridge) (submittedVersion)
  • Apollo
Funders
National Institute for Health and Care Research (NIHR200201, NF-SI-0611-10273, NIHR-RP-02-12-015, IS-SPC-0514-10043, RP-PG-1209-10051, NF-SI-0514-10121)
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
  • Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
Keywords
self-measured blood pressure, remote patient monitoring, cost-effectiveness, primary care, Markov model, quality-adjusted life years, cardiovascular mortality, usual care
MeSH terms
Antihypertensive Agents, Blood Pressure, Blood Pressure Determination, Cost-Benefit Analysis, Humans, Hypertension, Primary Health Care, Self Care, Telemedicine, Models, Economic

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