Cost-Effectiveness of a Hypertension Control Intervention in Three Community Health Centers in China

Bai, Yun; Zhao, Yanfang; Wang, Guijing; Wang, Hui-Cheng; Kejun, Liu; Wang, Zhao

doi:10.1177/2150131912470459

Cited by 13 publications

(15 citation statements)

References 24 publications

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“…That analysis did not report on hypertension treatment specifically and likely overestimated the net cost of the program by not including cost saved by preventing or delaying CVD events. Three cost-effectiveness analyses conducted in China used primary data to demonstrate that implementing community health center-based hypertension management programs is effective and inexpensive, but cost-effectiveness was not measured based on prevented CVD or life-year gains [ 31 – 33 ].…”

Section: Discussionmentioning

confidence: 99%

The Cost-Effectiveness of Low-Cost Essential Antihypertensive Medicines for Hypertension Control in China: A Modelling Study

Coxson

et al. 2015

PLoS Med

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BackgroundHypertension is China’s leading cardiovascular disease risk factor. Improved hypertension control in China would result in result in enormous health gains in the world’s largest population. A computer simulation model projected the cost-effectiveness of hypertension treatment in Chinese adults, assuming a range of essential medicines list drug costs.Methods and FindingsThe Cardiovascular Disease Policy Model-China, a Markov-style computer simulation model, simulated hypertension screening, essential medicines program implementation, hypertension control program administration, drug treatment and monitoring costs, disease-related costs, and quality-adjusted life years (QALYs) gained by preventing cardiovascular disease or lost because of drug side effects in untreated hypertensive adults aged 35–84 y over 2015–2025. Cost-effectiveness was assessed in cardiovascular disease patients (secondary prevention) and for two blood pressure ranges in primary prevention (stage one, 140–159/90–99 mm Hg; stage two, ≥160/≥100 mm Hg). Treatment of isolated systolic hypertension and combined systolic and diastolic hypertension were modeled as a reduction in systolic blood pressure; treatment of isolated diastolic hypertension was modeled as a reduction in diastolic blood pressure. One-way and probabilistic sensitivity analyses explored ranges of antihypertensive drug effectiveness and costs, monitoring frequency, medication adherence, side effect severity, background hypertension prevalence, antihypertensive medication treatment, case fatality, incidence and prevalence, and cardiovascular disease treatment costs. Median antihypertensive costs from Shanghai and Yunnan province were entered into the model in order to estimate the effects of very low and high drug prices. Incremental cost-effectiveness ratios less than the per capita gross domestic product of China (11,900 international dollars [Int$] in 2015) were considered cost-effective. Treating hypertensive adults with prior cardiovascular disease for secondary prevention was projected to be cost saving in the main simulation and 100% of probabilistic simulation results. Treating all hypertension for primary and secondary prevention would prevent about 800,000 cardiovascular disease events annually (95% uncertainty interval, 0.6 to 1.0 million) and was borderline cost-effective incremental to treating only cardiovascular disease and stage two patients (2015 Int$13,000 per QALY gained [95% uncertainty interval, Int$10,000 to Int$18,000]). Of all one-way sensitivity analyses, assuming adherence to taking medications as low as 25%, high Shanghai drug costs, or low medication efficacy led to the most unfavorable results (treating all hypertension, about Int$47,000, Int$37,000, and Int$27,000 per QALY were gained, respectively). The strengths of this study were the use of a recent Chinese national health survey, vital statistics, health care costs, and cohort study outcomes data as model inputs and reliance on clinical-trial-based estimates of coronary heart disease and s...

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Section: Discussionmentioning

confidence: 99%

The Cost-Effectiveness of Low-Cost Essential Antihypertensive Medicines for Hypertension Control in China: A Modelling Study

Coxson

et al. 2015

PLoS Med

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“…Another six studies 29 , 30 , 33 , 34 , 36 , 38 evaluated the cost effectiveness of educational interventions for both lifestyle change and medication adherence. All except one found the interventions were cost saving or cost effective.…”

Section: Evidence Synthesismentioning

confidence: 99%

A Systematic Review of Economic Evidence on Community Hypertension Interventions

Zhang

Wang

Joo

2017

American Journal of Preventive Medicine

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Context Effective community-based interventions are available to control hypertension. It is important to determine the economics of these interventions. Evidence acquisition Peer-reviewed studies from January 1995 through December 2015 were screened. Interventions were categorized into educational interventions, self-monitoring interventions, and screening interventions. Incremental cost-effectiveness ratios were summarized by types of interventions. The review was conducted in 2016. Evidence synthesis Thirty-four articles were included in the review (16 from the U.S., 18 from other countries), including 25 on educational interventions, three on self-monitoring interventions, and six on screening interventions. In the U.S., five (31.3%) studies on educational interventions were cost saving. Among the studies that found the interventions cost effective, the median incremental costs were $62 (range, $40–$114) for 1-mmHg reduction in systolic blood pressure (SBP) and $13,986 (range, $6,683–$58,610) for 1 life-year gained. Outside the U.S., educational interventions cost from $0.62 (China) to $29 (Pakistan) for 1-mmHg reduction in SBP. Self-monitoring interventions, evaluated in the U.S. only, cost $727 for 1-mmHg reduction in SBP and $41,927 for 1 life-year gained. For 1 quality-adjusted life-year, screening interventions cost from $21,734 to $56,750 in the U.S., $613 to $5,637 in Australia, and $7,000 to $18,000 in China. Intervention costs to reduce 1 mmHg blood pressure or 1 quality-adjusted life-year were higher in the U.S. than in other countries. Conclusions Most studies found that the three types of interventions were either cost effective or cost saving. Quality of economic studies should be improved to confirm the findings.

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“…Furthermore, in order to promote the grading diagnosis and treatment system, the rationality of medical resource allocation, and the formation of a sound medical treatment pattern, the government encourages patients to seek medical treatment at primary and secondary medical institutions by increasing the reimbursement ratios for these institutions. This also assists in reducing patients' OOP expenses …”

Section: Discussionmentioning

confidence: 99%

Total per‐visit medical expenses incurred by outpatients with diabetes—Evidence from six provinces in eastern China

Zhang

Yang

2019

Health Planning & Management

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Background: Chronic diseases associated with diabetes threaten the health of Chinese people and contribute to poverty. Methods: Medical service utilization records of 78 124 visits by outpatients with diabetes to medical institutions in China's eastern region between 2013 and 2015 were randomly selected from the Medical Insurance Department (MID) database. One-way analysis of variance (ANOVA) was used to compare the average total per-visit, out-ofpocket (OOP), and medical insurance (MI) fund expenses between variables. Multiple linear regression analysis was performed to identify possible risk factors affecting total per-visit medical expenses. Results: Average total per-visit medical expenses were 244.59, 285.56, and 435.33 yuan in primary, secondary, and tertiary medical institutions, respectively. Significant differences were found for average total per-visit medical expenses by year of visit, age, type of medical insurance, and levels of medical institutions. No significant differences were found for average total per-visit medical expenses by gender. Conclusion: The functions of medical networks at all levels should be clarified and the Urban Resident Basic Medical Insurance (URBMI) reimbursement ratio improved to ensure equal access to medical services irrespective of medical insurance type. Patients with chronic diseases should be

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Cost-Effectiveness of a Hypertension Control Intervention in Three Community Health Centers in China

Abstract: Background-Hypertension and associated chronic diseases impose enormous and growing health and economic burdens worldwide. The objective of this study was to investigate the costeffectiveness (CE) of a hypertension control program in China.

Cited by 13 publications

References 24 publications

The Cost-Effectiveness of Low-Cost Essential Antihypertensive Medicines for Hypertension Control in China: A Modelling Study

The Cost-Effectiveness of Low-Cost Essential Antihypertensive Medicines for Hypertension Control in China: A Modelling Study

A Systematic Review of Economic Evidence on Community Hypertension Interventions

Total per‐visit medical expenses incurred by outpatients with diabetes—Evidence from six provinces in eastern China

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