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尼日利亚抗高血压药物的成本效用分析:决策分析。

Cost-utility analysis of antihypertensive medications in Nigeria: a decision analysis.

机构信息

Department of Clinical Pharmacy and Pharmacy Management, Faculty of Pharmaceutical Sciences, University of Nigeria Nsukka, 410001, Enugu, Nigeria.

出版信息

Cost Eff Resour Alloc. 2013 Jan 23;11(1):2. doi: 10.1186/1478-7547-11-2.

Abstract

BACKGROUND

Many drugs are available for control of hypertension and its sequels in Nigeria but some are not affordable for majority of the populace. This serious pharmacoeconomic question has to be answered by the nation's health economists. The objective of this study was to evaluate the cost-effectiveness of drugs from 4 classes of antihypertensive medications commonly used in Nigeria in management of hypertension without compelling indication to use a particular antihypertensive drug.

METHODS

The study employed decision analytic modeling. Interventions were obtained from a meta-analysis. The Markov process model calculated clinical outcomes and costs during a life cycle of 30 years of 1000 hypertensive patients stratified by 3 cardiovascular risk groups, under the alternative intervention scenarios. Quality adjusted life year (QALY) was used to quantify clinical outcome. The average cost of treatment for the 1000 patient was tracked over the Markov cycle model of the alternative interventions and results were presented in 2010 US Dollars. Probabilistic cost-effectiveness analysis was performed using Monte Carlo simulation, and results presented as cost-effectiveness acceptability frontiers. Expected value of perfect information (EVPI) and expected value of parameter perfect information (EVPPI) analyses were also conducted for the hypothetical population.

RESULTS

Thiazide diuretic was the most cost-effective option across the 3 cardiovascular risk groups. Calcium channel blocker was the second best for Moderate risk and high risk with a willingness to pay of at least 2000$/QALY. The result was robust since it was insensitive to the parameters alteration.

CONCLUSIONS

The result of this study showed that thiazide diuretic followed by calcium channel blocker could be a feasible strategy in order to ensure that patients in Nigeria with hypertension are better controlled.

摘要

背景

在尼日利亚,有许多药物可用于控制高血压及其并发症,但有些药物对于大多数民众来说负担不起。这个严重的药物经济学问题必须由国家的卫生经济学家来回答。本研究的目的是评估在没有使用特定降压药物的强制性指征的情况下,来自尼日利亚常用的 4 类降压药物中的药物在高血压管理方面的成本效益。

方法

本研究采用决策分析模型。干预措施来自荟萃分析。马尔可夫过程模型在 30 年的生命周期内计算了 1000 名高血压患者的临床结果和成本,这些患者分为 3 个心血管风险组,根据替代干预方案。质量调整生命年(QALY)用于量化临床结果。1000 名患者的治疗平均成本在替代干预方案的马尔可夫循环模型中进行跟踪,并以 2010 年美元表示。使用蒙特卡罗模拟进行概率成本效益分析,并以成本效益可接受性前沿图表示结果。还对假设人群进行了完美信息的期望价值(EVPI)和完美参数信息的期望价值(EVPPI)分析。

结果

噻嗪类利尿剂在 3 个心血管风险组中是最具成本效益的选择。钙通道阻滞剂对于中度和高度风险是第二好的选择,支付意愿至少为 2000 美元/QALY。结果是稳健的,因为它对参数变化不敏感。

结论

这项研究的结果表明,噻嗪类利尿剂其次是钙通道阻滞剂,可能是确保尼日利亚高血压患者得到更好控制的可行策略。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1abf/3567962/38e6e8fe677f/1478-7547-11-2-1.jpg

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