降低收缩压对减轻澳大利亚心血管疾病负担的成本效益。

IF 3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Current Problems in Cardiology Pub Date : 2024-09-19 DOI:10.1016/j.cpcardiol.2024.102859

Haeri Cho , Jinkyeong Lee , Alison Cao , Grant Choo Way Leong , Kathryn Chenh , Dina Abushanab , Clara Marquina , Zanfina Ademi (Professor)

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引用次数: 0

摘要

目的：心血管疾病（CVD）仍然是全球主要死因。本研究探讨了降低收缩压 (SBP) 对减少心血管疾病发病率的影响，并从医疗保健角度评估了此类干预措施的成本效益。研究还从医疗保健的角度评估了此类干预措施的成本效益：我们创建了一个综合矩阵来分析心血管疾病的风险因素（收缩压、吸烟、糖尿病和胆固醇），确定收缩压是影响最大的可改变风险因素。我们采用了经过验证的健康经济模型，该模型结合了集合队列风险方程来预测首次心血管疾病事件的 10 年风险，并考虑了参与者的性别、年龄、血压、胆固醇水平、糖尿病和吸烟状况。主要结果是增量成本效益比 (ICER)，以每质量调整生命年 (QALY) 的成本和寿命来衡量。在假设情况下，根据《2016 年高血压管理指南》（澳大利亚国家心脏基金会），我们将血压水平≥ 140 mmHg 的参与者的 SBP 降低了 20%。所有成本和结果均采用 5% 的贴现率：将SBP水平≥140 mmHg的参与者的SBP降低20%后，我们观察到心血管疾病死亡人数减少了4756例（1.21%），非致命心血管疾病事件减少了7877例（0.77%）。干预后，寿命和 QALY 分别增加了 26,252 年（0.03%）和 23,928 年（0.03%）。急性和慢性成本也有所降低，急性事件成本降低了 24,437,625 澳元（0.28%），慢性成本降低了 18,544,776 澳元（0.71%）。假设情况占主导地位（节省成本）：我们的研究结果表明，在人群水平上降低 SBP 可以节约成本，并对心血管疾病的预后和心血管疾病高危人群的相关成本产生显著的积极影响。

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Cost-effectiveness of lowering systolic blood pressure in reducing cardiovascular disease burden in Australia

Aim

Cardiovascular diseases (CVD) remain a leading global cause of death. This research examines the impact of lowering systolic blood pressure (SBP) on reducing CVD prevalence. It also assesses the cost-effectiveness of such interventions from a healthcare perspective.

Methods

A synthesis matrix was created to analyse CVD risk factors (SBP, smoking, diabetes, and cholesterol), identifying SBP as the most impactful modifiable risk factor. We utilised validated health economic model which incorporates pooled cohort risk equations to predict the 10-year risk of the first CVD event, factoring in participants' gender, age, SBP, cholesterol levels, diabetes, and smoking status. The primary outcome was the incremental cost-effectiveness ratio (ICER), measured in costs per quality-adjusted life years (QALYs) and years of life lived. In a hypothetical scenario, we reduced SBP by 20 % in participants with levels ≥140 mmHg, based on the 2016 Hypertension Management Guide (National Heart Foundation of Australia). A 5 % discount rate was applied to all costs and outcomes.

Results

After reducing SBP by 20 % in participants with levels ≥140 mmHg, we observed a decrease in CVD deaths by 4756 cases (1.21 %) and non-fatal CVD events by 7877 cases (0.77 %). Post-intervention, there was an increase in years of life lived and QALYs experienced by 26,252 years (0.03 %) and 23,928 years (0.03 %), respectively. Acute and chronic costs also decreased, with acute event costs reduced by AUD 24,437,625 (0.28 %) and chronic costs by AUD 18,544,776 (0.71 %). Hypothetical scenario was found to be dominant (cost-saving).

Conclusions

Our results demonstrate that reducing SBP at the population level is cost-saving and has a significant positive impact on cardiovascular outcomes and related costs for those at risk of CVD.

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来源期刊

Current Problems in Cardiology 医学-心血管系统

CiteScore

4.80

自引率

2.40%

发文量

392

审稿时长

6 days

期刊介绍： Under the editorial leadership of noted cardiologist Dr. Hector O. Ventura, Current Problems in Cardiology provides focused, comprehensive coverage of important clinical topics in cardiology. Each monthly issues, addresses a selected clinical problem or condition, including pathophysiology, invasive and noninvasive diagnosis, drug therapy, surgical management, and rehabilitation; or explores the clinical applications of a diagnostic modality or a particular category of drugs. Critical commentary from the distinguished editorial board accompanies each monograph, providing readers with additional insights. An extensive bibliography in each issue saves hours of library research.