Abstract
The 2011 NICE hypertension guideline (CG127) undertook a systematic review of the diagnostic accuracy of different blood pressure (BP) assessment methods to confirm the diagnosis of hypertension. The guideline also undertook a cost–utility analysis exploring the cost-effectiveness of the monitoring methods. A new systematic review was undertaken as part of the 2019 NICE hypertension guideline update (NG136). BP monitoring methods compared included Ambulatory BP, Clinic BP and Home BP. Ambulatory BP was the reference standard. The economic model from the 2011 guideline was updated with this new accuracy data. Home BP was more sensitive and specific than Clinic BP. Specificity improved more than sensitivity since the 2011 review. A higher specificity translates into fewer people requiring unnecessary treatment. A key interest was to compare Home BP and Ambulatory BP, and whether any improvement in Home BP accuracy would change the model results. Ambulatory BP remained the most cost-effective option in all age and sex subgroups. In all subgroups, Ambulatory BP was associated with lower costs than Clinic BP and Home BP. In all except one subgroup (females aged 40), Ambulatory BP was dominant. However, Ambulatory BP remained the most cost-effective option in 40-year-old females as the incremental cost-effectiveness ratio for Home BP versus Ambulatory BP was above the NICE £20,000 threshold. The new systematic review showed that the accuracy of both Clinic BP and Home BP has increased. However, Ambulatory BP remains the most cost-effective option to confirm a diagnosis of hypertension in all subgroups evaluated.
Highlights
Supplementary information The online version of this article contains supplementary material, which is available to authorized users.The 2011 National Institute of Health and Care Excellence (NICE) hypertension in adults guideline (CG127) [1] undertook a systematic review and economic analysis, to look at the diagnostic accuracy and cost-effectiveness of different blood pressure (BP) monitoring methods for confirming a diagnosis of hypertension
The 2011 review included 20 studies investigating the accuracy of different BP devices at various diagnostic thresholds compared with the Ambulatory BP reference standard
Meta-analysis was conducted with data from ten studies for the most commonly reported diagnostic thresholds (135/85 mmHg for Home BP, and 140/90 mmHg for Clinic BP, compared with a reference standard threshold of 135/85 mmHg for Ambulatory BP) [1]
Summary
The 2011 National Institute of Health and Care Excellence (NICE) hypertension in adults guideline (CG127) [1] undertook a systematic review and economic analysis, to look at the diagnostic accuracy and cost-effectiveness of different blood pressure (BP) monitoring methods for confirming a diagnosis of hypertension. As part of updating the Hypertension in adults guideline (NG136) in 2019 [4], a new systematic review on the diagnostic accuracy of BP monitoring methods for confirming a diagnosis of hypertension was performed. This new data was added to the 2011 guideline economic model to assess whether the updated accuracy data would affect the cost-effectiveness of different BP monitoring methods.
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
