| Cost-effectiveness of options for the diagnosis of high blood pressure in primary care: a modelling study. | |
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MedLine Citation:
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PMID: 21868086 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: The diagnosis of hypertension has traditionally been based on blood-pressure measurements in the clinic, but home and ambulatory measurements better correlate with cardiovascular outcome, and ambulatory monitoring is more accurate than both clinic and home monitoring in diagnosing hypertension. We aimed to compare the cost-effectiveness of different diagnostic strategies for hypertension. METHODS: We did a Markov model-based probabilistic cost-effectiveness analysis. We used a hypothetical primary-care population aged 40 years or older with a screening blood-pressure measurement greater than 140/90 mm Hg and risk-factor prevalence equivalent to the general population. We compared three diagnostic strategies-further blood pressure measurement in the clinic, at home, and with an ambulatory monitor-in terms of lifetime costs, quality-adjusted life years, and cost-effectiveness. FINDINGS: Ambulatory monitoring was the most cost-effective strategy for the diagnosis of hypertension for men and women of all ages. It was cost-saving for all groups (from -£56 [95% CI -105 to -10] in men aged 75 years to -£323 [-389 to -222] in women aged 40 years) and resulted in more quality-adjusted life years for men and women older than 50 years (from 0·006 [0·000 to 0·015] for women aged 60 years to 0·022 [0·012 to 0·035] for men aged 70 years). This finding was robust when assessed with a wide range of deterministic sensitivity analyses around the base case, but was sensitive if home monitoring was judged to have equal test performance to ambulatory monitoring or if treatment was judged effective irrespective of whether an individual was hypertensive. INTERPRETATION: Ambulatory monitoring as a diagnostic strategy for hypertension after an initial raised reading in the clinic would reduce misdiagnosis and save costs. Additional costs from ambulatory monitoring are counterbalanced by cost savings from better targeted treatment. Ambulatory monitoring is recommended for most patients before the start of antihypertensive drugs. FUNDING: National Institute for Health Research and the National Institute for Health and Clinical Excellence. |
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Authors:
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Kate Lovibond; Sue Jowett; Pelham Barton; Mark Caulfield; Carl Heneghan; F D Richard Hobbs; James Hodgkinson; Jonathan Mant; Una Martin; Bryan Williams; David Wonderling; Richard J McManus |
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Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't Date: 2011-08-23 |
Journal Detail:
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Title: Lancet Volume: 378 ISSN: 1474-547X ISO Abbreviation: Lancet Publication Date: 2011 Oct |
Date Detail:
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Created Date: 2011-10-03 Completed Date: 2011-10-19 Revised Date: 2012-05-09 |
Medline Journal Info:
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Nlm Unique ID: 2985213R Medline TA: Lancet Country: England |
Other Details:
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Languages: eng Pagination: 1219-30 Citation Subset: AIM; IM |
Copyright Information:
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Copyright © 2011 Elsevier Ltd. All rights reserved. |
Affiliation:
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National Clinical Guideline Centre, Royal College of Physicians, London, UK. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Blood Pressure Monitoring, Ambulatory* / economics Cardiovascular Diseases / etiology, mortality Cost-Benefit Analysis Costs and Cost Analysis England Female Humans Hypertension / complications, diagnosis*, economics, physiopathology Male Markov Chains Middle Aged Models, Statistical Quality-Adjusted Life Years Risk Factors Sensitivity and Specificity |
| Comments/Corrections | |
Comment In:
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Lancet. 2011 Oct 1;378(9798):1199-200
[PMID:
21868084
]
Lancet. 2012 Feb 25;379(9817):709-10; author reply 710 [PMID: 22364755 ] Rev Clin Esp. 2012 Apr;212(4):206 [PMID: 22570883 ] |
Erratum In:
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Lancet. 2011 Oct 1;378(9798):1218 |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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