Ionov M V, Zhukova O V, Zvartau N E, Konradi A O
Almazov National Medical Research Centre.
National Research University of Information Technologies, Mechanics and Optics.
Ter Arkh. 2021 Jan 10;93(1):30-40. doi: 10.26442/00403660.2021.01.200590.
Telehealth is a useful adjunct in hypertension (HTN) management. Despite obvious short-term clinical benefit, long-term social impact and cost-effectiveness have not been fully investigated.
Predictive modeling of long-term clinical and social outcomes and the cost-effectiveness analysis of blood pressure (BP) telemonitoring and remote counseling (BPTM) in patients with HTN.
A Markov cohort-based (1000 patients in each study arm) model was developed and adopted a 10-year time horizon with 12-month time cycles. Cost and outcome data collected from the three-month study of 240 patients (160 in BPTM group and 80 controls, 48 y.o.). All patients started at a non-complicated HTN well state with a certain possibility of disease progression in a number of health states over a discrete time period. BPTM was compared with usual care in terms of 10-year healthcare costs, quality adjusted life years (QALY) using a Ministry of Health of Russian Federation perspective.
In the long-term run when compared with usual care BPTM was more effective in terms mortality (67 versus 91 patients lost and 9.6 versus 9.71 life years gained) and costs (cost of illness 102 508 000 RUR versus 145 237 700 RUR). Taking quality of life measures into account, the effect of BPTM was also more pronounced (8.31 versus 7.82 QALYs gained). The resultant incremental cost-utility ratio for BPTM was 275 178.98 RUR/1 QALY gained/1 patient (134 837.70 RUR/0.49 QALY/1 patient).
According to the results of predictive modeling, implementation of BPTM into clinical practice is likely lead to reduced cardiovascular morbidity and mortality in a cost-effective way.
远程医疗是高血压（HTN）管理中的一项有用辅助手段。尽管有明显的短期临床益处，但其长期社会影响和成本效益尚未得到充分研究。
对高血压患者长期临床和社会结局进行预测建模，并对血压远程监测和远程咨询（BPTM）进行成本效益分析。
开发了基于马尔可夫队列的模型（每个研究组1000例患者），采用10年时间跨度，时间周期为12个月。成本和结局数据来自对240例患者（年龄48岁）进行的为期三个月的研究（BPTM组160例，对照组80例）。所有患者均从非复杂性高血压良好状态开始，在离散时间段内有一定可能性在多种健康状态下病情进展。从俄罗斯联邦卫生部的角度，就10年医疗保健成本、质量调整生命年（QALY）方面，将BPTM与常规护理进行比较。
从长期来看，与常规护理相比，BPTM在死亡率方面更有效（死亡患者分别为67例和91例，获得的生命年分别为9.6年和9.71年）以及成本方面（疾病成本为102 508 000卢布，而145 237 700卢布）。考虑到生活质量指标，BPTM的效果也更显著（获得的QALY分别为8.31和7.82）。BPTM产生的增量成本效益比为每获得1个QALY/1例患者275 178.98卢布（每0.49个QALY/1例患者134 837.70卢布）。
根据预测建模结果，将BPTM应用于临床实践可能会以具有成本效益的方式降低心血管疾病的发病率和死亡率。
