The Cost Implications of Less Tight Versus Tight Control of Hypertension in Pregnancy (CHIPS Trial).
The Cost Implications of Less Tight Versus Tight Control of Hypertension in Pregnancy (CHIPS Trial).
复制标题
DOI：
10.1161/hypertensionaha.116.07466
复制
发表时间：
2016-10
期刊：
影响因子：
--
通讯作者：
Magee LA
中科院分区：
文献类型：
--
作者：
Ahmed RJ;Gafni A;Hutton EK;Hu ZJ;Pullenayegum E;von Dadelszen P;Rey E;Ross S;Asztalos E;Murphy KE;Menzies J;Sanchez JJ;Ganzevoort W;Helewa M;Lee SK;Lee T;Logan AG;Moutquin JM;Singer J;Thornton JG;Welch R;Magee LA
文本中提供了补充数字内容。CHIPS随机对照试验（妊娠期高血压控制研究）发现，在慢性或妊娠期高血压女性中，计划的“不太紧张”（目标舒张压100 mm Hg）和“紧张”（目标舒张压85 mm Hg）血压管理策略在主要围产期或次要母体结局方面没有差异。本研究从第三方支付者的角度探讨了这些管理策略中哪一种成本更高或更低。共有981名单胎妊娠且患有非重度、非蛋白尿性慢性或妊娠期高血压的妇女在14 - 33周时被随机分为不太严格或严格控制组。从15个国家的94个中心收集了所用资源，并计算了成本，就像在加拿大3个省进行的试验一样，作为成本敏感性分析。11个医院病房和24个卫生服务费用从一个类似的试验和省政府医疗保险计划的医疗福利。在控制不严格的情况下，每对母婴的平均总成本高于控制严格的情况，但在任何省份，平均总成本（DM）的差异均无统计学意义：安大略（30 191.62美元对24 469.06美元; 5723马克，95%置信区间，− 296美元至12 272美元; P=0.0725）;不列颠哥伦比亚省（30 593.69美元对24 776.51美元; 5817马克; 95%置信区间，− 385美元至12 349美元; P=0.0725）;或阿尔伯塔（31 510.72美元对25 510.49美元; 6000.23马克; 95%置信区间，-154至12 781美元; P=0.0637）。严格控制可能使妇女受益，而不会增加新生儿的风险（如主要CHIPS试验所示），也不会增加（可能降低）医疗保健系统的成本。URL：http://www.clinicaltrials.gov。唯一标识符：NCT 01192412。
Supplemental Digital Content is available in the text. The CHIPS randomized controlled trial (Control of Hypertension in Pregnancy Study) found no difference in the primary perinatal or secondary maternal outcomes between planned “less tight” (target diastolic 100 mm Hg) and “tight” (target diastolic 85 mm Hg) blood pressure management strategies among women with chronic or gestational hypertension. This study examined which of these management strategies is more or less costly from a third-party payer perspective. A total of 981 women with singleton pregnancies and nonsevere, nonproteinuric chronic or gestational hypertension were randomized at 14 to 33 weeks to less tight or tight control. Resources used were collected from 94 centers in 15 countries and costed as if the trial took place in each of 3 Canadian provinces as a cost-sensitivity analysis. Eleven hospital ward and 24 health service costs were obtained from a similar trial and provincial government health insurance schedules of medical benefits. The mean total cost per woman–infant dyad was higher in less tight versus tight control, but the difference in mean total cost (DM) was not statistically significant in any province: Ontario ($30 191.62 versus $24 469.06; DM $5723, 95% confidence interval, −$296 to $12 272; P=0.0725); British Columbia ($30 593.69 versus $24 776.51; DM $5817; 95% confidence interval, −$385 to $12 349; P=0.0725); or Alberta ($31 510.72 versus $25 510.49; DM $6000.23; 95% confidence interval, −$154 to $12 781; P=0.0637). Tight control may benefit women without increasing risk to neonates (as shown in the main CHIPS trial), without additional (and possibly lower) cost to the healthcare system. URL: http://www.clinicaltrials.gov. Unique identifier: NCT01192412.