在斯里兰卡轻中度高血压患者中，固定剂量、低剂量三联复方降压药物与常规治疗相比：TRIUMPH 试验的试验内和模型经济评估。
Fixed-combination, low-dose, triple-pill antihypertensive medication versus usual care in patients with mild-to-moderate hypertension in Sri Lanka: a within-trial and modelled economic evaluation of the TRIUMPH trial.
机构信息
The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia; Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.
The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia; Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.
出版信息
Lancet Glob Health. 2019 Oct;7(10):e1359-e1366. doi: 10.1016/S2214-109X(19)30343-2. Epub 2019 Aug 30.
BACKGROUND
Elevated blood pressure incurs a major health and economic burden, particularly in low-income and middle-income countries. The Triple Pill versus Usual Care Management for Patients with Mild-to-Moderate Hypertension (TRIUMPH) trial showed a greater reduction in blood pressure in patients using fixed-combination, low-dose, triple-pill antihypertensive therapy (consisting of amlodipine, telmisartan, and chlorthalidone) than in those receiving usual care in Sri Lanka. We aimed to assess the cost-effectiveness of the triple-pill strategy.
METHODS
We did a within-trial (6-month) and modelled (10-year) economic evaluation of the TRIUMPH trial, using the health system perspective. Health-care costs, reported in 2017 US dollars, were determined from trial records and published literature. A discrete-time simulation model was developed, extrapolating trial findings of reduced systolic blood pressure to 10-year health-care costs, cardiovascular disease events, and mortality. The primary outcomes were the proportion of people reaching blood pressure targets (at 6 months from baseline) and disability-adjusted life-years (DALYs) averted (at 10 years from baseline). Incremental cost-effectiveness ratios were calculated to estimate the cost per additional participant achieving target blood pressure at 6 months and cost per DALY averted over 10 years.
FINDINGS
The triple-pill strategy, compared with usual care, cost an additional US$9·63 (95% CI 5·29 to 13·97) per person in the within-trial analysis and $347·75 (285·55 to 412·54) per person in the modelled analysis. Incremental cost-effectiveness ratios were estimated at $7·93 (95% CI 6·59 to 11·84) per participant reaching blood pressure targets at 6 months and $2842·79 (-28·67 to 5714·24) per DALY averted over a 10-year period.
INTERPRETATION
Compared with usual care, the triple-pill strategy is cost-effective for patients with mild-to-moderate hypertension. Scaled up investment in the triple pill for hypertension management in Sri Lanka should be supported to address the high population burden of cardiovascular disease.
FUNDING
Australian National Health and Medical Research Council.
背景
高血压会带来重大的健康和经济负担，尤其是在低收入和中等收入国家。在轻度至中度高血压患者中，三重药物治疗（复方制剂，低剂量，三联降压治疗）与常规护理相比，可显著降低血压，三重药物治疗由氨氯地平、替米沙坦和氯噻酮组成，这一结果来自于斯里兰卡的 Triple Pill versus Usual Care Management for Patients with Mild-to-Moderate Hypertension（TRIUMPH）试验。本研究旨在评估三联药物治疗策略的成本效益。
方法
我们对 TRIUMPH 试验进行了试验内（6 个月）和模型（10 年）的经济学评估，采用卫生系统视角。根据试验记录和已发表文献确定了 2017 年以美元计价的医疗保健成本。开发了一个离散时间模拟模型，将试验中收缩压降低的结果外推至 10 年的医疗保健成本、心血管疾病事件和死亡率。主要结局是达到血压目标的人数比例（从基线起 6 个月）和避免的残疾调整生命年（DALYs）（从基线起 10 年）。计算增量成本效益比以估计每增加一名在 6 个月时达到目标血压的参与者的成本和每避免 10 年 DALY 的成本。
结果
与常规护理相比，在试验内分析中，三重药物治疗策略每人增加 9.63 美元（95%CI 5.29 至 13.97 美元），在模型分析中每人增加 347.75 美元（285.55 至 412.54 美元）。增量成本效益比估计为每达到血压目标的参与者增加 7.93 美元（95%CI 6.59 至 11.84 美元），每避免 10 年 DALY 增加 2842.79 美元（-28.67 至 5714.24 美元）。
结论
与常规护理相比，三重药物治疗策略对轻度至中度高血压患者具有成本效益。应支持在斯里兰卡扩大高血压管理的三重药物治疗投资，以应对心血管疾病的高人群负担。
资金来源
澳大利亚国家卫生和医学研究委员会。
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