Comparison of HTN Screening Strategies
| Dimension . | Option A (Clinic BP Alone) . | Option B (Clinic BP Confirmed by ABPM) . | Option C (ABPM Only) . | Preferred Option . | Assumptions Made . |
|---|---|---|---|---|---|
| Population: 170 cardiology, nephrology referred patients; analyzed at single-patient level | Auscultatory or oscillatory BP >95% | Auscultatory or oscillatory BP >90% then ABPM | Patients referred to provider who only used ABPM | — | — |
| Operational factors | |||||
| Percent adherence to care (goal of 80%) | Assumes 100% | Assumes 100% | Assumes 100% | — | — |
| Care delivery team effects | Baseline | Additional work to arrange or interpret confirmatory ABPM | Additional work to arrange and interpret ABPM for all patients | — | Assumes ABPM can be arranged and interpreted correctly |
| Patient, family effects | Baseline | Less desirable to have more visits; more desirable to have better accuracy | Family opinion depends on family’s values | — | |
| Benefits | |||||
| Clinical significance | Baseline | If HTN, treatment improves long-term outcome | If HTN, treatment improves long-term outcome | C | WCH estimated at 35%, ABPM results in fewer false-positive screening results |
| Cost of options | |||||
| Visit, diagnosis costs (annual estimated cost for 1 patient) | $1860 for visits and laboratory tests | $1330 for visits, ABPM, and laboratory tests | $1880 for visits, ABPM, and laboratory tests | B | — |
| Costs from complications, adverse events, nonoptimal treatment | |||||
| Likelihood of nonoptimal treatment | 60% undiagnosed patients; 35% of those diagnosed with WCH | 30% undiagnosed patients | All patients correctly diagnosed; fewer complications | C | Assumes treatment benefit for correctly diagnosed HTN has no complications |
| Costs of nonoptimal treatment | Increased mortality for not treating undiagnosed HTN; inconvenience of treatment of patients with WCH | Increased mortality for not treating undiagnosed HTN | All patients correctly diagnosed who are treated | C | — |
| Dimension . | Option A (Clinic BP Alone) . | Option B (Clinic BP Confirmed by ABPM) . | Option C (ABPM Only) . | Preferred Option . | Assumptions Made . |
|---|---|---|---|---|---|
| Population: 170 cardiology, nephrology referred patients; analyzed at single-patient level | Auscultatory or oscillatory BP >95% | Auscultatory or oscillatory BP >90% then ABPM | Patients referred to provider who only used ABPM | — | — |
| Operational factors | |||||
| Percent adherence to care (goal of 80%) | Assumes 100% | Assumes 100% | Assumes 100% | — | — |
| Care delivery team effects | Baseline | Additional work to arrange or interpret confirmatory ABPM | Additional work to arrange and interpret ABPM for all patients | — | Assumes ABPM can be arranged and interpreted correctly |
| Patient, family effects | Baseline | Less desirable to have more visits; more desirable to have better accuracy | Family opinion depends on family’s values | — | |
| Benefits | |||||
| Clinical significance | Baseline | If HTN, treatment improves long-term outcome | If HTN, treatment improves long-term outcome | C | WCH estimated at 35%, ABPM results in fewer false-positive screening results |
| Cost of options | |||||
| Visit, diagnosis costs (annual estimated cost for 1 patient) | $1860 for visits and laboratory tests | $1330 for visits, ABPM, and laboratory tests | $1880 for visits, ABPM, and laboratory tests | B | — |
| Costs from complications, adverse events, nonoptimal treatment | |||||
| Likelihood of nonoptimal treatment | 60% undiagnosed patients; 35% of those diagnosed with WCH | 30% undiagnosed patients | All patients correctly diagnosed; fewer complications | C | Assumes treatment benefit for correctly diagnosed HTN has no complications |
| Costs of nonoptimal treatment | Increased mortality for not treating undiagnosed HTN; inconvenience of treatment of patients with WCH | Increased mortality for not treating undiagnosed HTN | All patients correctly diagnosed who are treated | C | — |
—, none.