Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health.
Johns Hopkins School of Nursing, Baltimore, MD.
Med Care. 2018 Feb;56(2):179-185. doi: 10.1097/MLR.0000000000000852.
Project ReD CHiP (reducing disparities and controlling hypertension in primary care) care management was a clinic-based intervention that aimed to improve blood pressure control through improved care coordination and provide self-management support to patients from racially and socioeconomically.
To evaluate the cost-effectiveness of ReD CHiP care management versus standard care to treat hypertension in diverse communities.
Microsimulation model from a health care sector perspective over 15 years. We used the published literature to inform our model including the ReD CHiP trial and the age-specific and race-specific cardiovascular disease risk equations. Deterministic and probabilistic sensitivity analyses were conducted to assess the uncertainty.
Primary prevention in a racially diverse setting.
Costs per quality-adjusted life years (QALYs) to produce an incremental cost-effectiveness ratio (ICER).
ReD CHiP had an increase of $2114 and 0.04 QALYs. The ICER was $52,850/QALY. Predominately African American (ICER: $48,250/QALY) and elderly populations (ie, age 65+) derived value from ReD CHiP (ICER: $39,525/QALY). The value of ReD CHiP varied with changes in the reduction in systolic blood pressure (5 mm Hg reduction, ICER: $133,300/QALY; 15 mm Hg reduction, ICER: $18,767/QALY). Probabilistic sensitivity analysis indicated that ReD CHiP CM was cost-effective in over 90% of simulations, based on a willingness-to-pay of $100,000/QALY.
ReD CHiP care management is cost-effective to prevent negative consequences of hypertension. African American and elderly patients have more favorable ICERs, recommending targeted interventions to improve health equity among vulnerable patient populations.
项目 ReD CHiP（减少初级保健中的差异和控制高血压）的护理管理是一种基于诊所的干预措施，旨在通过改善护理协调来提高血压控制水平，并为来自不同种族和社会经济背景的患者提供自我管理支持。
评估 ReD CHiP 护理管理与标准护理在不同社区治疗高血压的成本效益。
从医疗保健部门的角度来看，这是一个为期 15 年的微观模拟模型。我们使用已发表的文献来为我们的模型提供信息，包括 ReD CHiP 试验以及年龄特异性和种族特异性心血管疾病风险方程。进行了确定性和概率敏感性分析，以评估不确定性。
在种族多样化的环境中进行初级预防。
每增加一个质量调整生命年（QALY）的成本，以产生增量成本效益比（ICER）。
ReD CHiP 的增加了$2114 和 0.04 QALY。ICER 为$52850/QALY。主要是非洲裔美国人（ICER：$48250/QALY）和老年人（即年龄 65 岁以上）从 ReD CHiP 中获得了价值（ICER：$39525/QALY）。ReD CHiP 的价值随收缩压降低的变化而变化（5mmHg 降低，ICER：$133300/QALY；15mmHg 降低，ICER：$18767/QALY）。概率敏感性分析表明，基于 100000 美元/QALY 的支付意愿，ReD CHiP CM 在超过 90%的模拟中具有成本效益。
ReD CHiP 护理管理可有效预防高血压的不良后果。非洲裔美国人和老年人的 ICER 更有利，建议针对弱势患者群体进行有针对性的干预，以改善健康公平。
