Cost-effectiveness analysis of hypertension guidelines in South Africa - Absolute risk versus blood pressure level
Cost-effectiveness analysis of hypertension guidelines in South Africa - Absolute risk versus blood pressure level
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DOI：
10.1161/circulationaha.105.535922
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发表时间：
2005-12-06
期刊：
影响因子：
37.8
通讯作者：
Opie, LH
中科院分区：
文献类型：
--
作者：
Gaziano, TA;Steyn, K;Opie, LH
背景--高血压在全球范围内比其他心血管危险因素造成更多的死亡.与基于绝对心血管疾病（CVD）风险的方法相比，基于血压水平开始治疗高血压的指南可能过于昂贵，特别是在发展中国家。我们比较了6种开始药物治疗的策略- 2种不同的血压水平（160/95和140/90 mm Hg）和10年内4种不同水平的绝对CVD风险（40%，30%，20%和15%）-其中一种没有治疗。我们模拟了一个假设的队列，所有成年人没有CVD在南非，一个多民族的发展中国家，超过10年。治疗10年CVD绝对风险> 40%、30%、20%和15%的患者的增量成本-效果比分别为每增加质量调整生命年700美元、1600美元、4900美元和11000美元。基于目标血压水平的策略比基于绝对CVD风险> 15%的策略的治疗决策更昂贵且效果更差。敏感性分析的治疗费用，患病率估计的危险因素，并从治疗预期的好处并没有改变排名的strategies.Conclusions -在南非，目前的指导方针的基础上血压水平都更昂贵，更有效的比指导方针的基础上的心血管疾病的绝对风险。使用基于风险的量化指南治疗高血压可以腾出大量资源用于其他迫切需要，特别是在发展中国家。
Background - Hypertension is responsible for more deaths worldwide than any other cardiovascular risk factor. Guidelines based on blood pressure level for initiation of treatment of hypertension may be too costly compared with an approach based on absolute cardiovascular disease (CVD) risk, especially in developing countries.Methods and Results - Using a Markov CVD model, we compared 6 strategies for initiation of drug treatment - 2 different blood pressure levels (160/95 and 140/90 mm Hg) and 4 different levels of absolute CVD risk over 10 years (40%, 30%, 20%, and 15%) - with one of no treatment. We modeled a hypothetical cohort of all adults without CVD in South Africa, a multiethnic developing country, over 10 years. The incremental cost-effectiveness ratios for treating those with 10-year absolute risk for CVD > 40%, 30%, 20%, and 15% were $700, $1600, $4900, and $11000 per quality-adjusted life-year gained, respectively. Strategies based on a target blood pressure level were both more expensive and less effective than treatment decisions based on the strategy that used absolute CVD risk of > 15%. Sensitivity analysis of cost of treatments, prevalence estimates of risk factors, and benefits expected from treatment did not change the ranking of the strategies.Conclusions - In South Africa, current guidelines based on blood pressure levels are both more expensive and less effective than guidelines based on absolute risk of cardiovascular disease. The use of quantitative risk-based guidelines for treatment of hypertension could free up major resources for other pressing needs, especially in developing countries.