Cost-effectiveness of the introduction of home blood pressure measurement in patients with office hypertension
Cost-effectiveness of the introduction of home blood pressure measurement in patients with office hypertension
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DOI：
10.1097/hjh.0b013e3282f42285
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发表时间：
2008-04-01
影响因子：
4.9
通讯作者：
Imai, Yutaka
中科院分区：
文献类型：
--
作者：
Fukunaga, Hidefumi;Ohkubo, Takayoshi;Imai, Yutaka
目的高血压治疗的成本效益在西方和包括日本在内的东方国家都是一个重要的社会和医学问题。家庭血压（HBP）测量对心血管事件的预测能力比临时诊所血压（CBP）测量更强。因此，引入HBP测量用于高血压的诊断和治疗应该会导致医疗费用的减少。本研究提出了计算的成本节约可能发生时，HBP是实施新发现的高血压受试者在Japan.Design和方法，我们估计从日本的医疗保健系统的角度节省的成本。为了估计从CBP改为HBP测量作为诊断工具的相关成本，我们使用Ohasama研究的数据构建了一个模拟模型。这些计算是基于目前估计的治疗费用，白大衣高血压的患病率在基线，和不同的新的高血压的发病率后，初步screening.Results当HBP测量不纳入诊断过程中，医疗费用估计为1089万美元每1000名受试者每5年。当纳入HBP测量时，每1000名受试者每5年的医疗成本估计为933万美元。每1000例患者每5年治疗高血压可减少医疗费用67.4万~ 251万美元，敏感性分析结果表明，引入HBP测量治疗高血压可有效降低医疗费用。
Objective Cost-effectiveness of hypertension treatment is an important social and medical issue in Western as well as in Eastern countries, including Japan. Home blood pressure (HBP) measurements have a stronger predictive power for cardiovascular events than casual clinic blood pressure (CBP) measurements. Therefore, the introduction of HBP measurement for the diagnosis and treatment of hypertension should lead to a decrease in medical expenditure. This study presents calculations of the cost savings likely to take place when HBP is implemented for newly detected hypertensive subjects in Japan.Design and methods We estimate the cost savings from the perspective of a Japanese healthcare system. To estimate the costs associated with changing from CBP to HBP measurement as the diagnostic tool, we constructed a simulation model using data from the Ohasama study. These calculations are based on current estimates for cost of treatment, prevalence of white-coat hypertension at baseline, and varying the incidence of new hypertension after the initial screening.Results When HBP measurement is not incorporated into the diagnostic process, the medical cost is estimated at US$ 10.89 million per 1000 subjects per 5 years. When HBP measurement is incorporated, the medical cost is estimated at US$ 9.33 million per 1000 subjects per 5 years. The reductions in medical costs vary from US$ 674 000 to US$ 2.51 million per 1000 subjects per 5 years for treatment of hypertension, when sensitivity analysis is performed.Conclusions The introduction of HBP measurement for the treatment of hypertension is very useful for reducing medical costs.