Economic evaluation of home blood pressure telemonitoring: a randomized controlled trial.

AIMS: The purpose of the present study was to compare the costs of home blood pressure (BP) telemonitoring (HBPM) with the costs of conventional office BP monitoring. In a randomized controlled trial, 105 hypertensive patients performed HBPM and 118 patients received usual care with conventional office BP monitoring during 6 months. Costs were quantified from the healthcare perspective. Non-parametric simulations were performed to quantify the uncertainty around the mean estimates and cost-effectiveness acceptability curves were made. MAJOR FINDINGS: Systolic and diastolic daytime and night-time ambulatory BP (ABP) were reduced in both groups. The uncertainty around the incremental cost effectiveness ratio point estimates was considerable for both systolic and diastolic ABP. For systolic ABP, the difference in cost effectiveness ratio between the two groups was 256 Danish kroner (DKK)/mmHg [95% uncertainty interval, UI -860 to 4544]. For diastolic ABP, the difference in cost effectiveness ratio between the two groups was 655 DKK/mmHg [95% UI -674 to 69315]. Medication and consultation costs were lowest in the intervention group, but were offset by the cost of the telemonitoring equipment. CONCLUSIONS: Cost-effectiveness analysis showed that telemonitoring of home BP was more costly compared with usual monitoring of office BP. The cost-effectiveness result is surrounded with considerable uncertainty.

Health-related quality of life (SF-36) during telemonitoring of home blood pressure in hypertensive patients: a randomized, controlled study.

Telemonitoring of home blood pressure (BP) is a new advance in home BP monitoring (HBPM) and has proved effective in improving BP control. The impact of telemedical HBPM on health-related quality of life (HRQOL) has not yet been studied. The purpose of this study is to compare HRQOL using a generic scale (SF-36) in patients with antihypertensive treatment based on telemedical HBPM and in patients with antihypertensive treatment based on conventional monitoring of office BP. Hypertensive patients (n = 223) recruited by general practitioners participated in the study. In the intervention group, antihypertensive treatment was based on telemedical HBPM. In the control group, patients (n = 118) received usual care with office visits to monitor BP. After 6 months, participants filled out SF-36 questionnaires. Patients in the telemonitoring group (T) had higher mean scores in the bodily pain domain than patients in the control group (C), indicating less pain and interference with activities among telemonitored patients [T: 85.3(20.2), C: 78.3(26.4), p = 0.026)]. Patients were more likely to feel their general health had worsened during the last year if antihypertensive treatment was based on conventional office measurements. In the bodily pain domain and health transition scale, scores were slightly better among telemonitored patients compared with control patients.

Blood pressure control during telemonitoring of home blood pressure. A randomized controlled trial during 6 months.

AIM: To compare the effectiveness of antihypertensive treatment based on telemonitoring of home blood pressure (BP) and conventional monitoring of office BP. METHODS: Hypertensive patients (n = 236) participated in a randomized, controlled study. In the intervention group, antihypertensive treatment was based on home BP monitoring. BP readings were registered by a PDA and automatically transmitted to a server, by which the patient and doctor could communicate. In the control group, patients received usual care with office visits to adjust antihypertensive treatment as needed. Primary outcome was difference in systolic daytime ambulatory BP monitoring (ABPM) change between baseline and 6 months. RESULTS: In both groups, systolic daytime ABPM decreased significantly from baseline to follow-up. The decrease in systolic daytime ABPM was -11.9 mmHg in the intervention group and -9.6 mmHg in the control group (mean difference -2.3 [95% CI -6.1 to -1.5], p = 0.225). The likelihood of daytime ABPM normalization was similar in the two groups [32/113 (28%) vs 46/123 (37%), p = 0.139]. CONCLUSION: Antihypertensive treatment based on telemonitoring of home BP was as effective as usual monitoring of office BP with regards to reduction of BP.