泰国南邦省HEARTS高血压项目初级保健费用。

IF 2.6 Q2 MEDICINE, GENERAL & INTERNAL
Piyachon Aramrat, Chanchanok Aramrat, Thomas Taeksung Kim, Muhammad Jami Husain, Soumava Basu, Saudamini Dabak, Wanrudee Isaranuwatchai, Nutchar Wiwatkunupakarn, Apichard Sukonthasarn, Chaisiri Angkurawaranon, Deliana Kostova, Andrew E Moran
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引用次数: 0

摘要

背景:2020年,在泰国南邦省的初级保健机构启动了高血压控制试点项目。该项目遵循HEARTS项目的框架,用于标准化高血压治疗,但该项目的财务成本尚不清楚。本研究评估了HEARTS方法与常规护理相比的成本,为该计划未来的扩大工作提供信息。方法:使用HEARTS成本工具收集成本数据并进行分析。HEARTS成本工具是一种基于Microsoft excel的工具,从卫生系统的角度支持HEARTS计划的作业成本计算。考虑了三种情况:常规护理,HEARTS方案使用标准的单药高血压治疗,以及HEARTS方案的子方案使用单药双药联合药丸。从卫生系统的角度来看,所有南邦初级保健设施的成本估计为年度成本。结果:在常规护理方案、HEARTS单丸方案和HEARTS联合丸子方案中,每位治疗患者的年平均用药费用分别为14.0美元(485泰铢)、13.8美元(479泰铢)和14.3美元(497泰铢)。在三种情况下,每位初级保健用户的总项目成本分别为13.6美元(472.7泰铢)、14.3美元(494.5泰铢)和14.4美元(499.9泰铢)。最大的项目成本驱动因素(45-47%)归因于适用于所有高血压患者的综合实验室检测包。假设,将所有高血压患者(占初级保健使用者的27%)的检测覆盖率降低到初级保健使用者的15%(相当于65岁以上患者的比例),将使HEARTS联合用药方案中每位使用者的项目成本从14.3美元降低到12.0美元。结论:与常规护理相比,HEARTS的实施成本包括员工培训的额外成本,这与使用HEARTS单药标准化方案的较低药物支出相平衡。据估计,使用双药联合药丸的HEARTS方案的费用略高,因为联合药丸的价格较高。优化诊断检测的覆盖范围和降低复方药物的购买价格是未来扩大工作中降低成本的关键领域。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Costs of the HEARTS hypertension program in primary care in Lampang province, Thailand.

Background: In 2020, a pilot program for hypertension control was initiated in primary care facilities in Lampang Province, Thailand. The program followed the framework of the HEARTS program for standardized hypertension treatment, but the financial costs of the program are not well understood. This study evaluates the costs of the HEARTS approach compared to usual care to inform future scale-up efforts of the program.

Methods: Cost data were collected and analyzed using the HEARTS costing tool, a Microsoft Excel-based tool that supports activity-based costing of the HEARTS program from the health system perspective. Three scenarios were considered: usual care, the HEARTS regimen using standardized hypertension treatment with single-agent pills, and a sub-scenario of the HEARTS regimen using single-pill dual-drug combination pills. Costs are estimated as annual costs from the health system perspective in all Lampang primary care facilities.

Results: For the usual care scenario, the HEARTS single-pill scenario, and the HEARTS combination-pill sub-scenario, the average annual medication cost per treated patient was USD 14.0 (THB 485), USD 13.8 (THB 479), and USD 14.3 (THB 497), respectively. Total program cost per primary care user was USD 13.6 (THB 472.7), THB USD 14.3 (494.5), and USD 14.4 (THB 499.9) across the three scenarios, respectively. The largest program cost driver (45-47% across the examined scenarios) was attributed to a comprehensive package of laboratory tests applied to all hypertension patients. Hypothetically, reducing test coverage from all hypertension patients (27% of primary care users) to 15% of primary care users (corresponding to the proportion of patients aged 65+) would reduce program cost per user from USD 14.3 to USD 12.0 in the HEARTS combination-pill scenario.

Conclusions: Compared to usual care, HEARTS implementation costs include additional costs for staff training, which are balanced by lower medication expenditures using the HEARTS standardized regimen with single-agent pills. The HEARTS regimen using dual-drug combination pills was estimated to be slightly more costly due to the higher price of combination pills. Optimizing coverage of diagnostic tests and lowering the purchasing prices of combination-pill medicines are key areas for cost reduction in future scale-up efforts.

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