Cost implications of improving blood pressure management among U.S. adults.
Cost implications of improving blood pressure management among U.S. adults.
复制标题
改善美国成年人血压管理的成本影响。
DOI：
10.1111/j.1475-6773.2010.01239.x
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发表时间：
2011
影响因子：
3.4
通讯作者：
McGlynn,Elizabeth
中科院分区：
文献类型：
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作者：
Nuckols,TerylK;Aledort,JuliaE;Adams,John;Lai,Julie;Go,Myong-Hyun;Keesey,Joan;McGlynn,Elizabeth
目的：从支付者的角度检验改善血压管理的成本效益。数据来源/研究设置。来自社区质量指数（CQI）研究的4，500名美国成年高血压患者的病历数据（1996-2002），来自四个马萨诸塞州健康计划的药品索赔（2004-2006年），医疗保险费用表（2009年），研究设计。概率树描述了2年内的血压管理。数据收集/提取方法：我们确定CQI研究受试者接受推荐护理过程和达到公认治疗目标的频率，估计与推荐护理相关的就诊和药物的利用率，根据利用率分配成本，然后建模如果提供所有推荐护理，住院率、成本和目标实现将如何变化。每年每个高血压患者增加170例（2009年美元）。2年内新达到治疗目标的人均增量成本为美元。总计1，696美元中度高血压801例，严重高血压850在患有严重高血压的人群中，血压会大幅下降，但很少达到目标;达到放松目标（≤第1阶段）的人均增量成本为美元。185.结论：在监测血压治疗目标实现情况的卫生保健有效性数据和信息集计划下，付款人会发现改善中度高血压的护理比改善重度高血压的护理更具成本效益。有一个次要的，放松的目标将大大增加支付者的动机，以改善严重高血压的护理。
Objective.To examine the cost‐effectiveness of improving blood pressure management from the payer perspective.Data Source/Study Setting.Medical record data for 4,500 U.S. adults with hypertension from the Community Quality Index (CQI) study (1996–2002), pharmaceutical claims from four Massachusetts health plans (2004–2006), Medicare fee schedule (2009), and published literature.Study Design.A probability tree depicted blood pressure management over 2 years.Data Collection/Extraction Methods.We determined how frequently CQI study subjects received recommended care processes and attained accepted treatment goals, estimated utilization of visits and medications associated with recommended care, assigned costs based on utilization, and then modeled how hospitalization rates, costs, and goal attainment would change if all recommended care was provided.Principal Findings.Relative to current care, improved care would cost payers U.S.$170 more per hypertensive person annually (2009 dollars). The incremental cost per person newly attaining treatment goals over 2 years would be U.S.$1,696 overall, U.S.$801 for moderate hypertension, and U.S.$850 for severe hypertension. Among people with severe hypertension, blood pressure would decline substantially but seldom reach goal; the incremental cost per person attaining a relaxed goal (≤stage 1) would be U.S.$185.Conclusions.Under the Health Care Effectiveness Data and Information Set program, which monitors the attainment of blood pressure treatment goals, payers will find it slightly more cost‐effective to improve care for moderate than severe hypertension. Having a secondary, relaxed goal would substantially increase payers' incentive to improve care for severe hypertension.