Economic rationale on the use of m-Health in uncontrolled hypertensive outpatients: from three months and beyond

Background/Introduction

Current scientific data show that blood pressure (BP) telemonitoring with/without additional counseling is rather effective in hypertension (HTN) management. However, cost-effectiveness and long-term social sequelae are lacking. This is because of diverse technologies and economic climate which make results highly heterogeneous across countries.

Purpose

To construct predictive model of long-term outcomes and to conduct the cost-effectiveness analysis of BP telemonitoring and remote counseling (BPTM) using m-Health in Russian population of outpatients with HTN.

Methods

Total of 240 patients were randomized (2:1) to either BPTM (n=160, mean age 47 y.o.) and to usual care (UC, n=80, mean age 49 y.o.) with baseline, three-month follow-up clinic visits combined with ambulatory BP measurement (ABPM). BPTM consisted of m-Health tool for patients, desktop module for clinicians. It enables BP data transfer and analysis, secure web chatting to support and counsel. Main outcomes were change in office, ambulatory systolic (S) BP and rate of BP control. A Markov cohort-based (1000 patients per study arm) model was developed and adopted a 10-year time horizon with 12-month time cycles. 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. Incremental cost-effectiveness ratio (ICER), incremental cost-utility ratio (ICUR) represented economic analysis.

Results

BPTM was associated with steeper decrease in office, ambulatory SBP (−16,8 mm Hg and −8,9 mm Hg, respectively; p<0,05) with the same treatment intensity (2,4 drugs per patient). There were 102 (64%) and 11 (14%) patients with fully controlled HTN in BPTM and UC groups, respectively (OR 11,03 95% CI [5,4–22,5]). An ICER of BPTM resulted in additional 11,1 EUR/1 mm Hg/year. It is expected that BPTM will be at least 76% cost-effective as per relevant Russian willingness-to-pay threshold. In a modelled 10-year period BPTM was life-saving (9,71 vs 9,6 life years gained) and cheap (cost of illness 1,5 mln vs 2,1 mln EUR). BPTM was also more valuable (8,31 versus 7,82 QALYs gained) so the ICUR was 3601,47 EUR/QALY gained. Cost-effectiveness was further confirmed by one-way deterministic sensitivity analysis.

Conclusion

BPTM seems to be clinically and economically effective when implemented into clinical practice. It provides greater BP reduction, improves BP control short-term. In a long-term it is likely to reduce cardiovascular morbidity and mortality in a cost-effective way. Larger randomized studies are needed to confirm these pilot results.

Cost-effectiveness acceptability curve

Funding Acknowledgement

Type of funding source: Foundation. Main funding source(s): The Russian Scientific Foundation

P1554Is self-reported sleep-disordered breathing associated with increased cardiovascular risk?

Background

Sleep-disordered breathing (SDB) is associated with the increased cardiovascular (CV) morbidity and mortality. However, sleep apnea is not considered in the standard scales used for the risk stratification.

Purpose

We evaluated the association between self-reported SDB and SCORE risk (the 10-year risk of fatal CV events according to the systemic coronary risk evaluation) in the population-based sample from St Petersburg.

Methods

We selected 1555 subjects without previously known CV events (550 males, 35%; mean age 46.7±11.6 years old) out of 1600 participants of the population-based sample (from the epidemiological study ESSE-RF, St Petersburg). All subjects were interviewed (questions about lifestyle, medical history, complaints) using standard questionnaire. We assessed self-reported snore (“Do you snore?”) and sleep apnea (“Do you have sleep apneas?”). Affirmative response was considered diagnostic. Daytime sleepiness was assessed based on the answers >3 times/week to the question “How often have you been unable to refrain sleeping when required?”. The 10-year risk of fatal CV events was assessed by the SCORE high-risk charts calculator. For statistical analysis we used parametric statistics, frequency and contingency analyses (Chi-square), multiple logistic regression analysis (stepwise inclusion; the parameters not evaluated in the SCORE scale were considered, i.e. body mass index, glucose level, triglyceride, HDL-cholesterol, creatinine, C-reactive protein, self-reported insomnia).

Results

Based on the SCORE assessment the participants were divided as following: low risk (<1%) was the most predominant category (n=864, 55.6%); moderate risk (≥1% and <5%) was found in 468 (30.1%), high risk (5–10%) – in 184 (11.8%), and very high risk – in 39 (2.5%) subjects. In total, 740 (47.6%) subjects had snoring, while only 77 (5%) subjects reported sleep apneas. Neither self-reported snoring nor sleep apnea were associated with daytime sleepiness (p>0.05). High-to-very-high SCORE risk was found more often in subjects with self-reported snoring compared to non-snorers: 21.2% vs. 8.1%, respectively (Chi-square=54.3, p<0.001). At the same time no association was found between self-reported sleep apneas and cardiovascular risk. Logistic regression demonstrated an association between SCORE risk and self-reported snoring (OR=3.06 95% CI 2.25–4.16, p<0.001). Multiple regression analysis confirmed the impact of snoring in the increased SCORE risk (OR=2.16 95% CI 1.55–3.02, p<0.001) after adjustment for the other factors.

Conclusions

Our study demonstrated that in Russian population-based sample self-reported snoring (unlike self-reported sleep apnea) is associated with the increased 10-year risk of fatal CV events. The lack of association between SCORE risk and sleep apnea might be related to the subjective assessment based on the questionnaire.

Acknowledgement/Funding

The study was supported by the Grant of the President of Russian Federation for the Leading Scientific Schools of Russia (agreement No. 075-02-2018-57,