Wang Sen-Te, Lin Ting-Yu, Chen Tony Hsiu-Hsi, Chen Sam Li-Sheng, Fann Jean Ching-Yuan
Department of Family Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan.
Department of Family Medicine, Taipei Medical University Hospital, Taipei 10301, Taiwan.
J Pers Med. 2023 Jun 15;13(6):1001. doi: 10.3390/jpm13061001.
While a population-wide strategy involving lifestyle changes and a high-risk strategy involving pharmacological interventions have been described, the recently proposed personalized medicine approach combining both strategies for the prevention of hypertension has increasingly gained attention. However, a cost-effectiveness analysis has been hardly addressed. This study was set out to build a Markov analytical decision model with a variety of prevention strategies in order to conduct an economic analysis for tailored preventative methods.
The Markov decision model was used to perform an economic analysis of four preventative strategies: usual care, a population-based universal approach, a population-based high-risk approach, and a personalized strategy. In all decisions, the cohort in each prevention method was tracked throughout time to clarify the four-state model-based natural history of hypertension. Utilizing the Monte Carlo simulation, a probabilistic cost-effectiveness analysis was carried out. The incremental cost-effectiveness ratio was calculated to estimate the additional cost to save an additional life year.
The incremental cost-effectiveness ratios (ICER) for the personalized preventive strategy versus those for standard care were -USD 3317 per QALY gained, whereas they were, respectively, USD 120,781 and USD 53,223 per Quality-Adjusted Life Year (QALY) gained for the population-wide universal approach and the population-based high-risk approach. When the ceiling ratio of willingness to pay was USD 300,000, the probability of being cost-effective reached 74% for the universal approach and was almost certain for the personalized preventive strategy. The equivalent analysis for the personalized strategy against a general plan showed that the former was still cost-effective.
To support a health economic decision model for the financial evaluation of hypertension preventative measures, a personalized four-state natural history of hypertension model was created. The personalized preventive treatment appeared more cost-effective than population-based conventional care. These findings are extremely valuable for making hypertension-based health decisions based on precise preventive medication.
虽然已经描述了涉及生活方式改变的全人群策略和涉及药物干预的高风险策略，但最近提出的将这两种策略结合起来预防高血压的个性化医疗方法越来越受到关注。然而，成本效益分析却很少涉及。本研究旨在构建一个包含多种预防策略的马尔可夫分析决策模型，以便对量身定制的预防方法进行经济分析。
采用马尔可夫决策模型对四种预防策略进行经济分析：常规护理、基于人群的普遍方法、基于人群的高风险方法和个性化策略。在所有决策中，对每种预防方法中的队列进行长期跟踪，以阐明基于四状态模型的高血压自然病史。利用蒙特卡洛模拟进行概率成本效益分析。计算增量成本效益比，以估计挽救一个额外生命年的额外成本。
个性化预防策略相对于标准护理的增量成本效益比（ICER）为每获得一个质量调整生命年（QALY）节省3317美元，而基于人群的普遍方法和基于人群的高风险方法分别为每获得一个质量调整生命年120781美元和53223美元。当支付意愿的上限比率为300000美元时，普遍方法具有成本效益的概率达到74%，而个性化预防策略几乎肯定具有成本效益。个性化策略与总体计划的等效分析表明，前者仍然具有成本效益。
为支持用于高血压预防措施财务评估的健康经济决策模型，创建了一个个性化的基于四状态的高血压自然病史模型。个性化预防治疗似乎比基于人群的传统护理更具成本效益。这些发现对于基于精确预防用药做出基于高血压的健康决策极具价值。
