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Telemonitoring-based service redesign for the management of uncontrolled hypertension (HITS): cost and cost-effectiveness analysis of a randomised controlled trial
  1. Andrew Stoddart1,
  2. Janet Hanley2,
  3. Sarah Wild3,
  4. Claudia Pagliari3,
  5. Mary Paterson3,
  6. Steff Lewis3,
  7. Aziz Sheikh3,
  8. Ashma Krishan1,
  9. Paul Padfield4,
  10. Brian McKinstry3
  1. 1Edinburgh Clinical Trials Unit, University of Edinburgh, Western General Hospital, Edinburgh, Midlothian, UK
  2. 2School of Nursing, Midwifery and Social Care, Edinburgh Napier University, Edinburgh, UK
  3. 3The University of Edinburgh, Centre for Population Health Sciences, Edinburgh, UK
  4. 4Scottish Government, Edinburgh, UK
  1. Correspondence to Professor Brian McKinstry; brian.mckinstry{at}


Objectives To compare the costs and cost-effectiveness of managing patients with uncontrolled blood pressure (BP) using telemonitoring versus usual care from the perspective of the National Health Service (NHS).

Design Within trial post hoc economic evaluation of data from a pragmatic randomised controlled trial using an intention-to-treat approach.

Setting 20 socioeconomically diverse general practices in Lothian, Scotland.

Participants 401 primary care patients aged 29–95 with uncontrolled daytime ambulatory blood pressure (ABP) (≥135/85, but <210/135 mm Hg).

Intervention Participants were centrally randomised to 6 months of a telemonitoring service comprising of self-monitoring of BP transmitted to a secure website for review by the attending nurse/doctor and patient, with optional automated patient decision-support by text/email (n=200) or usual care (n-201). Randomisation was undertaken with minimisation for age, sex, family practice, use of three or more hypertension drugs and self-monitoring history.

Main outcome measures Mean difference in total NHS costs between trial arms and blinded assessment of mean cost per 1 mm Hg systolic BP point reduced.

Results Home telemonitoring of BP costs significantly more than usual care (mean difference per patient £115.32 (95% CI £83.49 to £146.63; p<0.001)). Increased costs were due to telemonitoring service costs, patient training and additional general practitioner and nurse consultations. The mean cost of systolic BP reduction was £25.56/mm Hg (95% CI £16.06 to £46.89) per patient.

Conclusions Over the 6-month trial period, supported telemonitoring was more effective at reducing BP than usual care but also more expensive. If clinical gains are maintained, these additional costs would be very likely to be compensated for by reductions in the cost of future cardiovascular events. Longer-term modelling of costs and outcomes is required to fully examine the cost-effectiveness implications.

Trial registration International Standard Randomised Controlled Trials, number ISRCTN72614272.

  • Health Economics
  • Health Services Administration & Management

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: and

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