Related Experiment Videos
Ambulatory blood pressure monitoring: is it cost-effective?
L R Krakoff1, C Schechter, M Fahs
1Department of Medicine (Hypertension Division), Mount Sinai School of Medicine, CUNY, NY 10029-6574.
Insights
Screening for mild hypertension using ambulatory blood pressure monitoring can improve cost-effectiveness. This method identifies fewer patients needing treatment compared to casual blood pressure measurement, without impacting life expectancy.
Area of Science:
- Cardiology
- Preventive Medicine
- Health Economics
Background:
- Hypertension detection and treatment are crucial for preventing cerebrovascular and coronary heart disease.
- Current strategies for mild hypertension are inefficient, leading to overtreatment and significant costs.
- Rising costs are partly due to newer, more expensive antihypertensive medications.
Purpose of the Study:
- To evaluate the cost-effectiveness of using ambulatory blood pressure monitoring (ABPM) in secondary screening for mild hypertension.
- To compare patient selection for treatment based on casual blood pressure versus ABPM.
Main Methods:
- Computer simulation of patient populations undergoing hypertension screening.
- Comparison of treatment selection rates between casual blood pressure measurement and ABPM with echocardiography for borderline cases.
- Analysis of life expectancy and cost-effectiveness.
Main Results:
- ABPM in secondary screening demonstrated higher specificity, potentially excluding 20-40% of false positives.
- The ABPM strategy selected only 6% of subjects for treatment, versus 23% with casual blood pressure measurement.
- No significant difference in calculated life expectancy was observed between the two screening strategies.
Conclusions:
- Ambulatory blood pressure monitoring can significantly enhance the specificity of secondary screening for mild hypertension.
- Implementing ABPM in hypertension screening may lead to substantial improvements in cost-effectiveness by reducing unnecessary treatments.
- This approach offers a more targeted and efficient method for managing mild hypertension.
Abstract:
The detection and treatment of hypertension can prevent cerebrovascular disease and, to some extent, coronary heart disease. For mild hypertension this process is not efficient because many patients must be treated with antihypertensive medication to benefit only a few. The costs of identification, diagnosis and drug treatment of mild hypertension are significant. These costs have increased recently, in part due to changing patterns of drug selection favoring newer agents. Primary and secondary screening for hypertension has relied on casual blood pressure measurement which has high sensitivity, but low specificity, i.e. many false-positives can be expected. Incorporation of ambulatory blood pressure monitoring into secondary screening has potential for greater specificity by excluding from treatment 20-40% of those initially identified as having mild hypertension. Computer analysis of simulated populations selected for treatment by either casual blood pressure or by use of ambulatory blood pressure monitoring with echocardiography (for borderline cases) demonstrates no difference in calculated life expectancy for the two groups. However, the former strategy selected 23% of the subjects for treatment, while the latter selected 6%. These results imply that appropriate use of ambulatory blood pressure monitoring in secondary screening of mild hypertension may have a significant impact on cost-effectiveness.