中国成人高血压患者心血管风险评估和管理的成本效益：一项模型研究

IF 4.3 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

American journal of preventive cardiology Pub Date : 2025-05-13 DOI:10.1016/j.ajpc.2025.101007

Siqi Lin , Liming Lin , Wenyao Peng , Xuan Liu , Xi Li , Jiapeng Lu , Shouling Wu

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引用次数: 0

摘要

目的：单纯降低血压不足以显著改善高血压患者的心血管风险。心血管风险评估和管理被推荐用于预防和控制心血管疾病（CVD），但其在中国现实环境中的成本效益尚不清楚。本研究评估了年龄≥35岁的中国高血压患者心血管风险的两种策略的获益和成本效益：他汀类药物治疗和生活方式管理+他汀类药物治疗。方法构建决策分析马尔可夫队列模型，评估10年及终生干预与不干预之间的健康效益和增量成本-效果比。参数包括脑卒中/心肌梗死（MI）发病率、全因死亡率、成本和卫生效用，提取自开滦研究、已发表的文献或公共数据集。敏感性分析评估了参数不确定性对基本情况分析结果的影响。结果：他汀类药物单独治疗高血压高危心血管患者，预计在10年时间内可避免847350例脑卒中、1412250例心肌梗死和5649900例全因死亡。生活方式管理结合他汀类药物治疗可以预防更多的心血管和死亡事件，并且具有很高的成本效益（1219.76美元/质量调整生命年vs人均国内生产总值12680.83美元）。在整个生命周期内，无论何时开始联合干预，都具有很高的成本效益，越早开始干预，在预防心血管事件方面的益处越大。敏感性分析证实了稳健的结果。结论：对≥35岁的高血压患者进行心血管风险评估和联合管理将产生实质性的健康收益，并且在中国是一种高成本效益的心血管疾病预防策略。

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Cost-effectiveness of cardiovascular risk assessment and management among adults with hypertension in China: A modelling study

Objective

Blood pressure reduction alone is insufficient for significant cardiovascular risk improvement in patients with hypertension. Cardiovascular risk assessment and management are recommended to prevent and control cardiovascular diseases (CVD), but their cost-effectiveness in real-world Chinese settings is unclear. This study evaluated the benefits and cost-effectiveness of two strategies based on cardiovascular risk in Chinese hypertensive patients aged ≥35 years: statin treatment and lifestyle management + statin treatment.

Methods

A decision-analytic Markov cohort model was constructed to estimate health benefits and incremental cost-effectiveness ratios between two interventions and no intervention over 10-year and lifetime horizons. Parameters including stroke/myocardial infarction (MI) incidence, all-cause mortality, costs, and health utilities were extracted from the Kailuan study, published literature, or public datasets. Sensitivity analyses assessed the influence of parameter uncertainty on the results of base-case analysis.

Results

Statin treatment alone in hypertensive patients with high cardiovascular risk was projected to avert 847,350 stroke cases, 1412,250 MI cases and 564,900 all-cause deaths over a 10-year time horizon. Lifestyle management combined with statin treatment could prevent more cardiovascular and death events and was highly cost-effective ($1219.76/quality-adjusted life-year vs. gross domestic product per capita $12,680.83). Over a lifetime horizon, it was highly cost-effective regardless of the age when the combined intervention was started, with earlier initiation yielding greater benefits in preventing cardiovascular events. Sensitivity analyses confirmed robust results.

Conclusion

Cardiovascular risk assessment and combined management in hypertensive individuals aged ≥35 years would generate substantial health gains and represent a highly cost-effective CVD prevention strategy in China.

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来源期刊

American journal of preventive cardiology Cardiology and Cardiovascular Medicine

CiteScore

6.60

自引率

0.00%

发文量

审稿时长

76 days