Kawachi I
Department of Medicine, Harvard Medical School, Boston, Massachusetts.
Pharmacoeconomics. 1992 Oct;2(4):324-34. doi: 10.2165/00019053-199202040-00007.
Optimal management of hypertension involves finding a balance among its benefits, risks and costs. Cost-effectiveness analysis helps to clarify not only the trade-offs between the costs and benefits of treatment, but also the trade-offs between the risks and benefits, and the costs and quality of therapy. Existing analyses of hypertension treatment suggest a consistent set of strategies by which cost-effectiveness may be improved. These include strategies to increase the effectiveness of therapy, such as excluding false-positive diagnoses of hypertension, and according higher priority to treating patients with sustained elevations of diastolic blood pressure above 100mm Hg. A complementary set of strategies involve reducing the costs of therapy by prescribing lower-cost first-step regimens, making use of the minimum effective dose for particular medicines and attempting step-down therapy for suitable patients. Consideration of economic factors in initiating hypertension treatment is consistent with sound clinical practice.
高血压的最佳管理需要在其益处、风险和成本之间找到平衡。成本效益分析不仅有助于阐明治疗成本与效益之间的权衡，还能明确风险与效益之间以及治疗成本与质量之间的权衡。现有的高血压治疗分析表明了一套一致的策略，通过这些策略可以提高成本效益。这些策略包括提高治疗效果的策略，例如排除高血压的假阳性诊断，并将更高的优先级给予舒张压持续高于100毫米汞柱的患者进行治疗。另一套互补的策略包括通过开低成本的初始治疗方案、使用特定药物的最低有效剂量以及尝试为合适的患者进行逐步减量治疗来降低治疗成本。在开始高血压治疗时考虑经济因素与合理的临床实践是一致的。
