RTI International, Research Triangle Park, NC 27709-2194, USA.
Am Heart J. 2011 Oct;162(4):786-793.e1. doi: 10.1016/j.ahj.2011.06.022. Epub 2011 Sep 9.
Translation of published guidelines to clinical practice through continuing medical education (CME) can be effective at changing provider practice patterns and patient outcomes. Yet, cost-effectiveness analyses of CME interventions are rare. This study analyzed the cost-effectiveness of a CME program for improving patient hypertension outcomes relative to usual care.
A CME, conducted by the Carolinas and Georgia chapter of the American Society of Hypertension, the Medical University of South Carolina, and the Heart Disease and Stroke Prevention Division of the South Carolina Department of Health and Environmental Control, trained primary care providers in evidence-based guidelines for hypertension prevention and control. A cost-effectiveness simulation model was created with inputs from primary data collection of program costs and secondary data analysis of the Hypertension Initiative Database for years 2000 through 2008. The data analysis consisted of a convenience sample of 8,183 patients in the Hypertension Initiative Database who saw a CME-trained provider at least once before and after the provider's training. Control patients saw providers who did not attend a CME program and were matched to CME patients using propensity score matching.
Incremental life-years gained (LYG) for CME compared with no intervention were 0.003 per patient. The incremental cost-effectiveness ratio was $39,494 ($19,184-$73,864) per LYG under optimistic assumptions and $54,755 ($32,423-$95,728) per LYG under pessimistic assumptions. These results were most sensitive to changes in the effectiveness of the intervention on systolic blood pressure.
The intervention is likely a cost-effective strategy to address hypertension in a real-world setting and can serve as a model for future innovations in hypertension prevention.
通过继续医学教育（CME）将已发表的指南转化为临床实践，可以有效地改变提供者的实践模式和患者的结局。然而，CME 干预措施的成本效益分析却很少见。本研究分析了一项 CME 计划在改善患者高血压结局方面相对于常规护理的成本效益，该计划提高了初级保健提供者对高血压预防和控制的循证指南的认识。
由美国高血压学会卡罗莱纳州和佐治亚州分会、南卡罗来纳医科大学以及南卡罗来纳州卫生与环境控制部心脏病和中风预防司共同实施的 CME 培训了初级保健提供者循证高血压预防和控制指南。使用从项目成本的原始数据收集和 2000 年至 2008 年高血压倡议数据库的二次数据分析中得到的数据，创建了一个成本效益模拟模型。数据分析包括高血压倡议数据库中 8183 名患者的便利样本，这些患者在接受 CME 培训的提供者接受培训前后至少见过一次。对照患者接受了未参加 CME 计划的提供者的治疗，并使用倾向评分匹配与 CME 患者进行匹配。
与无干预相比，CME 每例患者获得的增量生命年（LYG）为 0.003。在乐观假设下，CME 的增量成本效益比为每位 LYG 39494 美元（19184 美元至 73864 美元），在悲观假设下为每位 LYG 54755 美元（32423 美元至 95728 美元）。这些结果对干预措施对收缩压的有效性变化最为敏感。
该干预措施在现实环境中治疗高血压可能是一种具有成本效益的策略，可以作为高血压预防未来创新的模型。
