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 (Euro 940 vs Euro 238). Reaching the gold standard (ABPM) involved an after-cost of Euro 115 per patient. The results for a 5% discount rate showed a saving of Euro 68,883 if ABPM was performed in all the patients included in the study (n = 241, Euro 285 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.

Proposals for improvement of emergency rural health care.

Universal healthcare coverage is a right, and that includes emergency health care. The community expects such requirements to be within their reach, including all human and technological resources necessary for rapid and high-quality health assistance in an emergency. Access to and delivery of emergency care in rural areas is recognized as more difficult than that in urban areas. In this report, following the EURIPA meeting in June 2004, the authors determine the problems of dealing with emergencies in the rural healthcare context, and also make proposals for improvement.