Health Economics and Policy Evaluation Research (HEPER) Group, Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia.
Health Economics and Policy Evaluation Research (HEPER) Group, Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
Curr Probl Cardiol. 2024 Dec;49(12):102859. doi: 10.1016/j.cpcardiol.2024.102859. Epub 2024 Sep 19.
Cardiovascular diseases (CVD) remain a leading global cause of death. This research examines the impact of lowering systolic blood pressure (SBP) on reducing CVD prevalence. It also assesses the cost-effectiveness of such interventions from a healthcare perspective.
A synthesis matrix was created to analyse CVD risk factors (SBP, smoking, diabetes, and cholesterol), identifying SBP as the most impactful modifiable risk factor. We utilised validated health economic model which incorporates pooled cohort risk equations to predict the 10-year risk of the first CVD event, factoring in participants' gender, age, SBP, cholesterol levels, diabetes, and smoking status. The primary outcome was the incremental cost-effectiveness ratio (ICER), measured in costs per quality-adjusted life years (QALYs) and years of life lived. In a hypothetical scenario, we reduced SBP by 20 % in participants with levels ≥140 mmHg, based on the 2016 Hypertension Management Guide (National Heart Foundation of Australia). A 5 % discount rate was applied to all costs and outcomes.
After reducing SBP by 20 % in participants with levels ≥140 mmHg, we observed a decrease in CVD deaths by 4756 cases (1.21 %) and non-fatal CVD events by 7877 cases (0.77 %). Post-intervention, there was an increase in years of life lived and QALYs experienced by 26,252 years (0.03 %) and 23,928 years (0.03 %), respectively. Acute and chronic costs also decreased, with acute event costs reduced by AUD 24,437,625 (0.28 %) and chronic costs by AUD 18,544,776 (0.71 %). Hypothetical scenario was found to be dominant (cost-saving).
Our results demonstrate that reducing SBP at the population level is cost-saving and has a significant positive impact on cardiovascular outcomes and related costs for those at risk of CVD.
心血管疾病（CVD）仍然是全球主要的死亡原因。本研究探讨降低收缩压（SBP）对降低 CVD 患病率的影响。它还从医疗保健的角度评估了此类干预措施的成本效益。
创建了综合矩阵来分析 CVD 风险因素（SBP、吸烟、糖尿病和胆固醇），确定 SBP 是最具影响力的可改变风险因素。我们利用了经过验证的健康经济模型，该模型结合了汇总队列风险方程来预测首次 CVD 事件的 10 年风险，考虑了参与者的性别、年龄、SBP、胆固醇水平、糖尿病和吸烟状况。主要结果是增量成本效益比（ICER），以每质量调整生命年（QALY）和生命年的成本来衡量。在一个假设的场景中，我们根据 2016 年高血压管理指南（澳大利亚国家心脏基金会）将参与者中 SBP 水平≥140mmHg 的 SBP 降低 20%。对所有成本和结果应用了 5%的折扣率。
在将 SBP 水平≥140mmHg 的参与者的 SBP 降低 20%后，我们观察到 CVD 死亡人数减少了 4756 例（1.21%），非致命性 CVD 事件减少了 7877 例（0.77%）。干预后，生活年限和 QALYs 分别增加了 26252 年（0.03%）和 23928 年（0.03%）。急性和慢性成本也有所下降，急性事件成本减少了 2443.7625 澳元（0.28%），慢性成本减少了 1854.4776 澳元（0.71%）。假设情况被发现是占优的（成本节约）。
我们的结果表明，在人群水平上降低 SBP 是成本节约的，并对 CVD 风险人群的心血管结果和相关成本产生显著的积极影响。
