Blood pressure telemonitoring and remote counseling in uncontrolled hypertension

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Abstract

Telehealth is a useful adjunct in hypertension (HTN) management. Despite obvious short-term clinical benefit, long-term social impact and cost-effectiveness have not been fully investigated.

Aim. Predictive modeling of long-term clinical and social outcomes and the cost-effectiveness analysis of blood pressure (BP) telemonitoring and remote counseling (BPTM) in patients with HTN.

Materials and methods. A Markov cohort-based (1000 patients in each study arm) model was developed and adopted a 10-year time horizon with 12-month time cycles. Cost and outcome data collected from the three-month study of 240 patients (160 in BPTM group and 80 controls, 48 y.o.). All patients started at a non-complicated HTN “well” state with a certain possibility of disease progression in a number of health states over a discrete time period. BPTM was compared with usual care in terms of 10-year healthcare costs, quality adjusted life years (QALY) using a Ministry of Health of Russian Federation perspective.

Results. In the long-term run when compared with usual care BPTM was more effective in terms mortality (67 versus 91 patients lost and 9.6 versus 9.71 life years gained) and costs (cost of illness 102 508 000 RUR versus 145 237 700 RUR). Taking quality of life measures into account, the effect of BPTM was also more pronounced (8.31 versus 7.82 QALYs gained). The resultant incremental cost-utility ratio for BPTM was 275 178.98 RUR/1 QALY gained/1 patient (134 837.70 RUR/0.49 QALY/1 patient).

Conclusion. According to the results of predictive modeling, implementation of BPTM into clinical practice is likely lead to reduced cardiovascular morbidity and mortality in a cost-effective way.

About the authors

Mikhail V. Ionov

Almazov National Medical Research Centre; National Research University of Information Technologies, Mechanics and Optics

Author for correspondence.
Email: ionov_mv@almazovcentre.ru
ORCID iD: 0000-0002-3664-5383

аспирант, мл. науч. сотр. научно-исследовательской лаб. патогенеза и терапии артериальной гипертензии научно-исследовательского отд. артериальной гипертензии ФГБУ «НМИЦ им. В.А. Алмазова», мл. науч. сотр. Института трансляционной медицины ФГАОУ ВО «Университет ИТМО»

Russian Federation, 2 Akkuratova str., Saint-Petersburg, 197341; Saint-Petersburg

Olga V. Zhukova

Privolzhsky Research Medical University

Email: ionov_mv@almazovcentre.ru
ORCID iD: 0000-0002-6454-1346

к.ф.н., доц. каф. управления и экономики фармации и фармацевтической технологии ФГБОУ ВО ПИМУ

Russian Federation, 10/1, Minin and Pozharsky square , Nizhny Novgorod, 603005

Nadezhda E. Zvartau

Almazov National Medical Research Centre; National Research University of Information Technologies, Mechanics and Optics

Email: ionov_mv@almazovcentre.ru
ORCID iD: 0000-0001-6533-5950

к.м.н., ст. науч. сотр. научно-исследовательского отд. артериальной гипертензии, зам. ген. дир. по работе с регионами, начальник Управления по реализации федеральных проектов, доц. каф. внутренних болезней Института медицинского образования ФГБУ «НМИЦ им. В.А. Алмазова», ст. науч. сотр. Института трансляционной медицины ФГАОУ ВО «Университет ИТМО»

Russian Federation, 2 Akkuratova str., Saint-Petersburg, 197341; Saint-Petersburg

Alexandra O. Konradi

Almazov National Medical Research Centre; National Research University of Information Technologies, Mechanics and Optics

Email: ionov_mv@almazovcentre.ru
ORCID iD: 0000-0001-8169-7812

чл.-кор. РАН, д.м.н., проф., зам. ген. дир. по научной работе, глава научно-исследовательского отд. артериальной гипертензии ФГБУ «НМИЦ им. В.А. Алмазова», дир. Института трансляционной медицины ФГАОУ ВО «Университет ИТМО».

Russian Federation, 2 Akkuratova str., Saint-Petersburg, 197341; Saint-Petersburg

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2. Fig. 1. Markov model of the transition of states associated with AG, in the case of using TMDK. An identical model was built for a cohort of patients in the control group (the differences concern only the probabilities of transition between states).

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3. Fig. 2. Results of a deterministic univariate analysis of the sensitivity of changes in the cost of hypertension therapy in a 10-year perspective (variable parameter - the cost of TMDK per patient per year, rubles); Tornado diagram.

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