Deng Bing-Hwa, Liu Hong-Wen, Pan Pi-Chen, Mau Lih-Wen, Chiu Herng-Chia
Management Office, Kaohsiung Municipal Hsiao-Kang Hospital, and Department of Family Medicine, Kaohsiung Medical University Hospital, Taiwan.
Kaohsiung J Med Sci. 2007 Jan;23(1):17-24. doi: 10.1016/S1607-551X(09)70369-9.
The National Health Insurance (NHI) and social welfare agencies have implemented the Elderly Health Examination Program (EHEP) for years. No study has ever attempted to evaluate whether this program is cost-effective. The purposes of this study were, firstly, to understand the prevalence and incidence rates of hypertension and, secondly, to estimate the cost and effectiveness of the EHEP, focusing on hypertension screening. The data sources were: (1) hypertension and clinical information derived from the 1996 and 1997 EHEP, which was used to generate prevalence and incidence rates of hypertension; and (2) claim data of the NHI that included treatment costs of stroke patients (in- and outpatients). Hypothetical models were used to evaluate the cost-effectiveness of the hypertension screening program in various conditions. Sensitivity analysis was also employed to evaluate the effect of each estimation indicator on the cost and effectiveness of the hypertension screening program. A total of 28.3% of the elderly population in Kaohsiung (25,174 of 88,812) participated in the 1996 EHEP; 14,915 of them participated in the following 1997 EHEP, with a retention rate of 59.3%. Criteria from the Sixth Report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI) (systolic blood pressure/diastolic blood pressure>or=160/95 mmHg or taking antihypertensive drugs) were used; we found that prevalence and incidence rates of hypertension were 24.6% and 6.6%, respectively. Hypertension rates are increasing in the aging process as shown in both prevalence and incidence models. In comparison with non-participants, the prevalence model indicates that each hypertension patient who had attended the EHEP not only saved NT$34,570-34,890 in medical and associated costs, but also increased their lifespan by 128 days. The present findings suggest that the EHEP is a cost-effective program with health and social welfare policy implications. With the relatively low participation rate of the EHEP, health and social agencies need to put more effort into the promotion of this free health examination program to attract potential participants. In doing so, the population at risk for hypertension would be identified for early treatment, and the probability of having stroke could be decreased. Consequently, health care expenditures for treatment and caregiving of stroke patients would be minimized. Finally, it should be noted that the sensitivity and values of selected parameters can modify the results of cost-effectiveness analysis. Interpretations of the effects of prevention services on costs and effectiveness need to be treated with caution.
国民健康保险（NHI）和社会福利机构多年来一直在实施老年健康检查计划（EHEP）。从未有研究试图评估该计划是否具有成本效益。本研究的目的，一是了解高血压的患病率和发病率，二是评估EHEP的成本和效果，重点是高血压筛查。数据来源为：（1）1996年和1997年EHEP得出的高血压及临床信息，用于得出高血压的患病率和发病率；（2）NHI的理赔数据，包括中风患者（门诊和住院）的治疗费用。使用假设模型评估高血压筛查计划在各种情况下的成本效益。还采用敏感性分析来评估每个估计指标对高血压筛查计划成本和效果的影响。高雄市共有28.3%的老年人口（88,812人中的25,174人）参加了1996年的EHEP；其中14,915人参加了随后的1997年EHEP，保留率为59.3%。采用美国国家高血压检测、评估与治疗联合委员会第六次报告（JNC VI）的标准（收缩压/舒张压>或=160/95 mmHg或正在服用降压药）；我们发现高血压的患病率和发病率分别为24.6%和6.6%。患病率和发病率模型均显示，高血压发病率在老龄化过程中呈上升趋势。与未参与者相比，患病率模型表明，每位参加EHEP的高血压患者不仅节省了34,570 - 34,890新台币的医疗及相关费用，还延长了128天的寿命。目前的研究结果表明，EHEP是一个具有成本效益的计划，对健康和社会福利政策具有启示意义。鉴于EHEP的参与率相对较低，卫生和社会机构需要更加努力地推广这个免费健康检查计划，以吸引潜在参与者。这样做可以识别出高血压高危人群以便早期治疗，并降低中风的发生概率。因此，中风患者的治疗和护理医疗费用将降至最低。最后需要指出的是，所选参数的敏感性和数值会改变成本效益分析的结果。对预防服务对成本和效果影响的解读需要谨慎对待。
