Kim KyungYi, Hong Min Ji, Kim Bomgyeol, Lee Hae-Young, Kim Tae Hyun
Department of Healthcare Management, Graduate School of Public Health, Yonsei University, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
Department of Medical Device Engineering and Management, Yonsei University Graduate School, Seoul, Republic of Korea.
Clin Hypertens. 2024 Nov 1;30(1):34. doi: 10.1186/s40885-024-00289-2.
Hypertension is a significant risk factor for cardiovascular disease (CVD), with hypertension-related deaths increasing annually. While South Korea uses the Korean Society of Hypertension (KSH) guideline of 140/90 mmHg, the American College of Cardiology (ACC) and American Heart Association (AHA) updated their guidelines in 2017 to 130/80 mmHg. This study evaluates the cost-effectiveness of transitioning to the 2017 ACC/AHA guidelines by estimating early treatment impacts and potential CVD risk reduction.
A Markov state-transition simulation model with a 10-year horizon was used to estimate cost-effectiveness, focusing on strengthening target blood pressure. Quality-adjusted life years (QALYs) served as the measure of effectiveness. Cohorts of 10,000 individuals representing South Koreans in their 20s through 80s were compared in scenario analyses from the healthcare system perspective. A 4.5% annual discount rate was applied to costs and effectiveness. Primary outcomes were incremental cost-effectiveness ratio (ICER) and net monetary benefit (NMB). The willingness-to-pay (WTP) threshold was < KRW 30,000,000/QALY gained. Probabilistic sensitivity analyses (PSAs) addressed model input parameter uncertainties.
The base-case analysis showed an ICER value of KRW 1,328,395/QALY gained across all populations. ICER values increased with age, from - KRW 3,138,071/QALY for 20-year-olds to KRW 16,613,013/QALY for individuals over 80. The 60s age group showed the greatest benefit with an incremental QALY gain of 0.46. All scenarios had ICERs below the WTP threshold, with a PSA probability of 98.0% that strengthening blood pressure classification could be cost-effective.
This economic evaluation found that adopting the 2017 ACC/AHA guidelines may result in early treatment, reduce the potential incidence of CVD events, and be cost-effective across all age groups. The study findings have implications for policymakers deciding whether and when to revise official guidelines regarding target blood pressure levels, considering the impacts on public health and budgetary concerns.
高血压是心血管疾病（CVD）的一个重要危险因素，与高血压相关的死亡人数每年都在增加。韩国采用韩国高血压学会（KSH）140/90 mmHg的指南，而美国心脏病学会（ACC）和美国心脏协会（AHA）在2017年将其指南更新为130/80 mmHg。本研究通过估计早期治疗影响和潜在的心血管疾病风险降低情况，评估转向2017年ACC/AHA指南的成本效益。
使用一个为期10年的马尔可夫状态转换模拟模型来估计成本效益，重点是强化目标血压。质量调整生命年（QALYs）作为有效性的衡量指标。从医疗保健系统的角度，在情景分析中比较了代表20多岁至80多岁韩国人的10000人队列。对成本和有效性应用4.5%的年贴现率。主要结果是增量成本效益比（ICER）和净货币效益（NMB）。支付意愿（WTP）阈值为每获得一个QALY<30000000韩元。概率敏感性分析（PSAs）解决了模型输入参数的不确定性。
基础案例分析显示，所有人群每获得一个QALY的ICER值为1328395韩元。ICER值随年龄增长而增加，从20岁人群的-3138071韩元/QALY增加到80岁以上人群的16613013韩元/QALY。60多岁年龄组受益最大，增量QALY增益为0.46。所有情景的ICER均低于WTP阈值，PSAs显示强化血压分类具有成本效益的概率为98.0%。
这项经济评估发现，采用2017年ACC/AHA指南可能会带来早期治疗，降低心血管疾病事件的潜在发生率，并且在所有年龄组中都具有成本效益。研究结果对政策制定者在决定是否以及何时修订关于目标血压水平的官方指南时具有启示意义，同时要考虑到对公共卫生和预算问题的影响。
