Li Qiaoqiao, Xu Teng, Hu Tianyang, Lou Yake
Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Precision Medicine Center, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Int J Technol Assess Health Care. 2024 Dec 9;40(1):e73. doi: 10.1017/S0266462324000461.
The China Rural Hypertension Control Project (CRHCP) is a nonphysician-led community-based hypertension intervention program that has demonstrated clear benefits in improving blood pressure (BP) control and reducing the incidence of cardiovascular disease events among hypertensive patients in rural areas of China. However, it is currently unclear whether the benefits of the CRHCP outweigh its costs, and whether promoting this project in China is justifiable from a perspective of healthcare system.
We employed a Markov model to forecast the anticipated 20-year costs and effectiveness of the CRHCP trial. Cost data for this study was gathered from public records or published papers, whereas clinical data was extracted from the CRHCP trial. Our primary outcome measure was the incremental cost-effectiveness ratio, expressed in Chinese Yuan (CNY) per quality-adjusted life-year (QALY), representing the additional cost per additional QALY gained.
Over a span of 20 years, the cost for a rural hypertensive individual in China who received intensive BP intervention by a nonphysician community healthcare provider would amount to 25,129 CNY, yielding an effectiveness of 8.19 QALY. In contrast, if usual care was provided, the cost would be 26,709 CNY with an effectiveness of 7.94 QALY. The CRHCP program demonstrated lower costs and greater effectiveness for rural hypertensive individuals in China.
Our study indicates that the implementation of the CRHCP program among rural hypertensive individuals in China resulted in increased effectiveness and reduced costs. From the perspective of Chinese healthcare system, the CRHCP program proves to be cost-saving within the current healthcare landscape.
中国农村高血压控制项目（CRHCP）是一项由非医生主导的基于社区的高血压干预项目，已在中国农村地区的高血压患者中显示出在改善血压（BP）控制和降低心血管疾病事件发生率方面的明显益处。然而，目前尚不清楚CRHCP的益处是否超过其成本，以及从医疗保健系统的角度来看在中国推广该项目是否合理。
我们采用马尔可夫模型来预测CRHCP试验预期的20年成本和效果。本研究的成本数据来自公共记录或已发表的论文，而临床数据则从CRHCP试验中提取。我们的主要结局指标是增量成本效益比，以每质量调整生命年（QALY）的人民币（CNY）表示，代表每获得一个额外的QALY所增加的成本。
在20年的时间里，在中国接受非医生社区医疗服务提供者强化血压干预的农村高血压患者的成本将达到25,129元人民币，产生8.19个QALY的效果。相比之下，如果提供常规护理，成本将为26,709元人民币，效果为7.94个QALY。CRHCP项目在中国农村高血压患者中显示出更低的成本和更高的效果。
我们的研究表明，在中国农村高血压患者中实施CRHCP项目可提高效果并降低成本。从中国医疗保健系统的角度来看，CRHCP项目在当前医疗保健格局下被证明是节省成本的。
