Montgomery Alan A, Fahey Tom, Ben-Shlomo Yoav, Harding James
Division of Primary Health Care, University of Bristol, UK.
J Hypertens. 2003 Sep;21(9):1753-9. doi: 10.1097/00004872-200309000-00026.
To estimate the effectiveness and cost-effectiveness of blood pressure-lowering treatment over a lifetime.
Markov decision analysis model comparing treatment and non-treatment of hypertension.
Hypothetical cohorts for 20 different strata of sex, age (30-79 years, in 10-year age bands), and cardiovascular risk (low and high risk).
Life expectancy, and incremental cost : effectiveness ratios for treatment and non-treatment strategies.
In terms of life expectancy, blood pressure treatment increased life expectancy in all age, sex, and risk strata, by between 1.6 and 10.3%, compared with a policy of non-treatment. In terms of cost-effectiveness, treatment was more effective, but also cost more than non-treatment for all age, sex, and risk strata except the oldest high-risk men and women. Incremental cost per quality-adjusted life year (QALY) among low-risk groups ranged from pound 1030 to pound 3304. Cost-effectiveness results for low-risk individuals were sensitive to the utility of receiving antihypertensive treatment. Treatment of high-risk individuals was highly cost-effective, such that it was the dominant strategy in the oldest age group, and resulted in incremental costs per QALY ranging from pound 34 to pound 265 in younger age groups.
Policy decisions about which patients to treat depend on whether a life-expectancy or cost-effectiveness perspective is taken. Treatment increases life expectancy in all strata of age, sex, and cardiovascular risk. However, younger individuals stand to gain proportionately more from blood pressure treatment than do the elderly. In terms of cost-effectiveness, patients at high risk of cardiovascular disease are a highly cost-effective group to treat. In patients at lower risk of cardiovascular disease, consideration should be given to issues of patient preference and cost.
评估终身降压治疗的有效性和成本效益。
采用马尔可夫决策分析模型比较高血压治疗与不治疗的情况。
针对20个不同性别、年龄（30 - 79岁，按10岁年龄组划分）和心血管风险（低风险和高风险）分层的假设队列。
预期寿命，以及治疗和不治疗策略的增量成本效益比。
在预期寿命方面，与不治疗策略相比，血压治疗使所有年龄、性别和风险分层的预期寿命提高了1.6%至10.3%。在成本效益方面，除了年龄最大的高风险男性和女性外，治疗在所有年龄、性别和风险分层中更有效，但成本也高于不治疗。低风险组中每质量调整生命年（QALY）的增量成本在1030英镑至3304英镑之间。低风险个体的成本效益结果对抗高血压治疗的效用敏感。高风险个体的治疗具有很高的成本效益，以至于在年龄最大的年龄组中它是主导策略，并且在较年轻的年龄组中每QALY的增量成本在34英镑至265英镑之间。
关于治疗哪些患者的政策决策取决于采取预期寿命还是成本效益的视角。治疗可提高所有年龄、性别和心血管风险分层的预期寿命。然而，年轻人从血压治疗中获得的相对收益比老年人更多。在成本效益方面，心血管疾病高风险患者是极具成本效益的治疗群体。对于心血管疾病低风险患者，应考虑患者偏好和成本问题。
