Cost-effectiveness of options for the diagnosis of high blood pressure in primary care: a modelling study
Cost-effectiveness of options for the diagnosis of high blood pressure in primary care: a modelling study
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DOI：
10.1016/s0140-6736(11)61184-7
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发表时间：
2011-10-01
期刊：
影响因子：
168.9
通讯作者：
McManus, Richard J.
中科院分区：
文献类型：
--
作者：
Lovibond, Kate;Jowett, Sue;McManus, Richard J.
背景高血压的诊断传统上是基于门诊血压测量，但家庭和动态测量与心血管结局更相关，动态监测在诊断高血压方面比门诊和家庭监测更准确。我们的目的是比较不同的高血压诊断策略的成本-效果。方法我们做了一个基于马尔可夫模型的概率成本-效果分析。我们使用了一个假设的初级保健人群，年龄在40岁或以上，筛查血压测量值大于140/90 mm Hg，风险因素患病率与普通人群相当。我们比较了三种诊断策略，进一步的血压测量在诊所，在家里，并与一个动态监测的终身成本，质量调整生命年，和cost-effectiveness.Findings动态监测是最具成本效益的战略，为所有年龄段的男性和女性的高血压的诊断。这对所有群体来说都是节省成本的（从75岁男性的-56磅[95% CI -105至-10]到40岁女性的-323磅[-389至-222]），并导致50岁以上男性和女性的质量调整生命年更多（从60岁妇女的0.006 [0.000至0.015]到70岁男子的0.022 [0.012至0.035]）。当围绕基本情况进行广泛的确定性敏感性分析进行评估时，这一发现是稳健的，但如果家庭监测与动态监测具有相同的测试性能，或如果无论个体是否患有高血压都判断治疗有效，则是敏感的。解释在门诊最初的阅读升高后，将动态监测作为高血压的诊断策略，可减少误诊并节省成本门诊监测的额外费用被更好的靶向治疗节省的费用所抵消。建议大多数患者在开始使用抗高血压药物前进行动态监测。
Background The diagnosis of hypertension has traditionally been based on blood-pressure measurements in the clinic, but home and ambulatory measurements better correlate with cardiovascular outcome, and ambulatory monitoring is more accurate than both clinic and home monitoring in diagnosing hypertension. We aimed to compare the cost-effectiveness of different diagnostic strategies for hypertension.Methods We did a Markov model-based probabilistic cost-effectiveness analysis. We used a hypothetical primary-care population aged 40 years or older with a screening blood-pressure measurement greater than 140/90 mm Hg and risk-factor prevalence equivalent to the general population. We compared three diagnostic strategies-further blood pressure measurement in the clinic, at home, and with an ambulatory monitor-in terms of lifetime costs, quality-adjusted life years, and cost-effectiveness.Findings Ambulatory monitoring was the most cost-effective strategy for the diagnosis of hypertension for men and women of all ages. It was cost-saving for all groups (from -56 pound [95% CI -105 to -10] in men aged 75 years to -323 pound [-389 to -222] in women aged 40 years) and resulted in more quality-adjusted life years for men and women older than 50 years (from 0.006 [0.000 to 0.015] for women aged 60 years to 0.022 [0.012 to 0.035] for men aged 70 years). This finding was robust when assessed with a wide range of deterministic sensitivity analyses around the base case, but was sensitive if home monitoring was judged to have equal test performance to ambulatory monitoring or if treatment was judged effective irrespective of whether an individual was hypertensive.Interpretation Ambulatory monitoring as a diagnostic strategy for hypertension after an initial raised reading in the clinic would reduce misdiagnosis and save costs. Additional costs from ambulatory monitoring are counterbalanced by cost savings from better targeted treatment. Ambulatory monitoring is recommended for most patients before the start of antihypertensive drugs.