Cost-effectiveness of ambulatory blood pressure monitoring in the follow-up of hypertension

Aims. To study the cost of the follow-up of hypertension in primary care (PC) using clinical blood pressure (CBP) and ambulatory blood pressure monitoring (ABPM), and to analyse the cost-effectiveness (CE) of both methods. Major findings and principal conclusion. Good control of hypertension was achieved in 8.3% with CBP (95% CI 4.8-11.8) and in 55.6% with ABPM (95% CI 49.3-61.9). The cost of one patient with good control of hypertension is almost four times higher with CBP than with ABPM (940euro vs 238euro). Reaching the gold standard (ABPM) involved an after-cost of 115euro per patient. The results for a 5% discount rate showed a saving of 68,883 if ABPM was performed in all the patients included in the study (n = 241, 285euro per patient). An analysis of sensitivity, changing the discount rate and life expectancy indicated that ABPM provides a better CE ratio and a lower global cost. ABPM is more cost-effective than CBP. However, if we include the new treatment cost of poorly monitored patients, it is less cost- effective. Excellent control of hypertension is still an important challenge for all healthcare professionals, especially for those working in PC, where most monitoring of hypertensive patients takes place.