中国130-139/80-89 mmHg血压且心血管风险高的成年人治疗的成本效益：一项建模研究
Cost-effectiveness of treatment in adults with blood pressure of 130-139/80-89 mmHg and high cardiovascular risk in China: a modelling study.
作者信息
Li Jiangtao, Zhao Dong, Cai Jun, Chen Shuohua, Wu Shouling, Qi Yue
机构信息
Center for Clinical and Epidemiologic Research, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, The Key Laboratory of Remodelling-Related Cardiovascular Diseases, Ministry of Education, Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing 100029, China.
Hypertension Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease of China, National Center for Cardiovascular Diseases of China, Chinese Academy of Medical Sciences and Peking Union Medical College, Beilishi Rd. 167, Xicheng District, Beijing 100037, China.
出版信息
Lancet Reg Health West Pac. 2023 Nov 17;42:100962. doi: 10.1016/j.lanwpc.2023.100962. eCollection 2024 Jan.
BACKGROUND
The most recent updated hypertension guidelines recommend individuals with systolic blood pressure (SBP)/diastolic blood pressure (DBP) of 130-139/80-89 mmHg and high cardiovascular risk should receive antihypertensive drug treatment. This study aimed to assess the benefits and cost-effectiveness of medication for people aged ≥35 years with this blood pressure stratum and high cardiovascular risk in China.
METHODS
The benefits of drug treatment in adults aged ≥35 years with SBP/DBP of 130-139/80-89 mmHg and high cardiovascular risk were evaluated in decision-analytic simulation models. Decreasing numbers of cardiovascular disease (CVD) events and premature deaths from all causes and increasing quality-adjusted life-years (QALYs) from drug treatment were estimated in 10-year and lifetime horizons. The incremental cost-effectiveness ratios (ICER) for drug treatment were calculated.
FINDINGS
Among approximately 106.60 million Chinese adults aged ≥35 years with this blood pressure stratum and high cardiovascular risk, drug treatment was estimated to prevent 2,060,000 strokes and 660,000 myocardial infarctions over a 10-year time horizon. Adults prescribed antihypertensive drugs could gain 0.034 incremental QALYs. Over a lifetime horizon, adults who start treatment earlier could benefit more in preventing CVD and gaining incremental QALYs. The medication treatment is cost-effective either over a 10-year time horizon with an ICER of Int$13321.29 per QALY gained or over the remaining lifetime.
INTERPRETATION
Antihypertensive treatment of adults with SBP/DBP of 130-139/80-89 mmHg and high cardiovascular risk would gain substantial benefits with cost-effectiveness. The young and middle-aged population would derive the most benefit.
FUNDING
National Natural Science Foundation of China, and Beijing Natural Science Foundation.
背景
最新更新的高血压指南建议，收缩压（SBP）/舒张压（DBP）为130 - 139/80 - 89 mmHg且心血管风险高的个体应接受降压药物治疗。本研究旨在评估在中国年龄≥35岁、处于该血压分层且心血管风险高的人群中药物治疗的益处和成本效益。
方法
在决策分析模拟模型中评估年龄≥35岁、SBP/DBP为130 - 139/80 - 89 mmHg且心血管风险高的成年人药物治疗的益处。在10年和终身范围内估计药物治疗使心血管疾病（CVD）事件和各种原因导致的过早死亡数量减少，以及质量调整生命年（QALY）增加。计算药物治疗的增量成本效益比（ICER）。
结果
在约1.066亿年龄≥35岁、处于该血压分层且心血管风险高的中国成年人中，估计药物治疗在10年时间范围内可预防206万例中风和66万例心肌梗死。服用降压药物的成年人可获得0.034个增量QALY。在终身范围内，更早开始治疗的成年人在预防CVD和获得增量QALY方面获益更多。药物治疗在10年时间范围内具有成本效益，ICER为每获得一个QALY 13321.29国际元，在剩余生命期内同样具有成本效益。
解读
对SBP/DBP为130 - 139/80 - 89 mmHg且心血管风险高的成年人进行降压治疗将带来显著益处且具有成本效益。中青年人群获益最大。
资助
中国国家自然科学基金和北京市自然科学基金。
Zotero 插件