Cost-Effectiveness of Noninvasive Central Blood Pressure Monitoring in the Diagnosis of Hypertension

Abstract

BACKGROUND: Central blood pressure (CBP) betters conventional clinical BP (cuff BP) in predicting cardiovascular outcomes. Noninvasive CBP monitoring has emerged as a new technology for management of hypertension. This study aimed to analyze the cost-effectiveness of noninvasive CBP compared to cuff BP monitoring for confirming a diagnosis of hypertension. METHODS: Lifetime costs and quality-adjusted life years (QALYs) were estimated for CBP and cuff BP monitoring using a cohort Markov model. We applied model calibration and probabilistic sensitivity analysis on populations representative of the general population, in 10-year age brackets, from age 35 years to over 75 years of age. RESULTS: The CBP strategy was more cost-effective than cuff BP for men and women across all age subgroups, with mean incremental cost-effectiveness ratios ranging from £226 to £2,750 per QALY gained. The cost-effectiveness was mainly driven by improved patient outcomes, represented by the QALY gains (0.09-0.88), at an acceptable incremental cost (£116-£371). Deterministic and probabilistic sensitivity analyses demonstrated the consistency and robustness of the cost-effectiveness of the CBP strategy. CONCLUSIONS: Early evidence on the diagnostic accuracy of noninvasive CBP monitoring suggests significant improvements in the confirmation of suspected hypertension, compared to cuff BP. This paper suggests that the long-term benefits of improved diagnostic performance justify the supplementary purchase costs of new, noninvasive CBP monitors. The results highlight the potential value of CBP, and hence the value of further research to confirm the diagnostic and prognostic role of CBP for the management of hypertension.