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

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.

Determining optimal strategies for primary prevention of cardiovascular disease: systematic review of cost-effectiveness analyses in the United Kingdom

“…The majority of studies were excluded because they were not full economic evaluations (see Appendix 2). Two further 49,50 studies were identified from weekly auto-alerts and the full texts of these studies were obtained. However, both studies 49,50 were excluded as they were not primary prevention studies.…”

“…Two further 49,50 studies were identified from weekly auto-alerts and the full texts of these studies were obtained. However, both studies 49,50 were excluded as they were not primary prevention studies. Eight studies [51][52][53][54][55][56][57][58] met the inclusion criteria of this systematic review.…”

A scoping review of hospital to home transitional care programmes for stroke survivors

“…Sharing disease knowledge with patients and maintaining interactive guidance with them through the Internet platform greatly stimulate patients' active compliance behaviour, which can effectively improve patients' medication compliance (Zhu et al, 2015). In recent years, evidence supporting that the use of blood pressure self-monitoring in the general population with stroke reduces the risk of recurrence and the financial burden of healthcare has been growing (Doogue et al, 2023;Kim et al, 2020;Schwartz et al, 2018). Therefore, further study should focus on blood pressure self-monitoring during the transition process.…”

Effect of self-management of stroke patients on rehabilitation based on patient-reported outcome

“…Existing research has suggested that self-management education (e.g., life management, sports management, treatment compliance management, and psychosocial factor management) can enhance the self-efficacy of stroke patients at the recovery stage. Patients can maintain and promote their health, reduce the effect of diseases, and firmly cope with their diseases ( Liu, 2019 ; Kim et al, 2020 ; He et al, 2022 ). The higher the self-management level of patients, the better the treatment compliance and the better the rehabilitation effect will be ( Gao et al, 2014a ; Dong et al, 2018 ; Shi et al, 2019 ).…”