Cost analysis of ambulatory blood pressure monitoring in initiating antihypertensive drug treatment in Australian general practice
Cost analysis of ambulatory blood pressure monitoring in initiating antihypertensive drug treatment in Australian general practice
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DOI：
10.5694/j.1326-5377.2002.tb04588.x
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发表时间：
2002-06-17
影响因子：
11.4
通讯作者：
Pekarsky, B
中科院分区：
文献类型：
--
作者：
Ewald, B;Pekarsky, B
目的：比较动态血压监测（ABPM）的费用与通过识别和不治疗“白大褂”高血压患者而避免治疗的推定节省的费用。设计：一项基于四种替代策略（无ABPM、每年、两年或三年监测）模型的成本分析，应用于澳大利亚全科医生的病例系列，为期7年。参与者：62名刚被全科医生诊断为高血压并需要药物治疗的患者。主要结局指标：显示不需要治疗的患者比例。药品福利计划、医疗福利计划和患者的折扣费用。结果：62例患者中有16例（26%;95% Cl, 15%-37%） ABPM血压正常，无需治疗。所有监测策略在第一年都比较昂贵，但第3年抵消了初始成本，此后监测策略就节省了成本。敏感性分析表明，这一结果适用于各种药物治疗费用和白大衣高血压患者的比例。结论：24小时ABPM第一年的额外费用被与白大衣高血压患者相关的节省所抵消，否则他们将接受治疗。
Objective: To compare the cost of ambulatory blood pressure monitoring (ABPM) with the putative savings made through treatment avoided by identification and non-treatment of those with "white coat" hypertension.Design: A cost analysis based on a model of four alternative strategies (no ABPM, yearly, two-yearly, or three-yearly monitoring) over a seven-year period applied to a case series from Australian general practice,Participants: 62 patients newly diagnosed by their GPs as having hypertension and requiring drug treatment.Main outcome measures: The proportion of patients shown to not need treatment. The discounted costs to the Pharmaceutical Benefits Scheme, Medical Benefits Scheme and patients.Results: 16 of 62 patients (26%; 95% Cl, 15%-37%) were normotensive on ABPM and did not require treatment. All monitoring strategies are more expensive in the first year, but the initial costs are offset by year 3 and the monitoring strategies are cost saving thereafter. Sensitivity analysis shows that this result holds across a range of costs of pharmacotherapy and proportion of patients with white coat hypertension.Conclusion: The additional costs of 24-hour ABPM in the first year are offset by savings associated with patients with white coat hypertension who would otherwise have been treated.