Chen Xiyin, Bishai David
School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.
Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
BMC Public Health. 2024 Dec 19;24(1):3540. doi: 10.1186/s12889-024-21005-7.
To identify the cost-effectiveness of four policy options related to folic acid supplements after considering the side effects of masking vitamin B12 (B12) deficiency in primary stroke prevention for hypertensive patients in China.
A cost-effectiveness analysis.
Four policies were considered: Policy A, Do nothing to address folate status in hypertensive patients at risk for stroke; Policy B, Folate supplementation without pre-screening for vitamin B12 deficiency; Policy C, Folate supplementation with pre-screening all patients for B12 deficiency and add B12 supplements if B12 is deficient; and Policy D, Folate supplementation only for those whose folate is deficient, pre-screen all patients for both B12 and folate deficiencies and add B12 supplements if B12 is deficient. A decision tree with a five-year period of intervention based on the China Stroke Primary Prevention Trial (CSPPT) from the Chinese healthcare system perspective estimated incremental cost-effectiveness ratio (ICER) for Policy B, Policy C and Policy D vs. Policy A.
At a willingness to pay (WTP) threshold of 3 times the national GDP per capita ($38,198), Policy B was not cost-effective compared to Policy A, with an ICER of $47,968 per QALY due to QALYs lost introduced by the delayed diagnosis of B12 deficiency and the potentially underestimated costs associated with treating neuropathy. However, Policy C and Policy D were cost-effective compared to Policy A, with an ICER of $32,615 and $20,287 per QALY, respectively. A probabilistic sensitivity analysis showed that there would be a 72.7% and 83.5% chance that the additional cost of Policy C and Policy D, compared with Policy A, was at or below the WTP threshold.
Folate supplementation with integrated screening for B12 and folate deficiencies is considered the most cost-effective strategy for primary stroke prevention in hypertensive elderly patients in China. Future research should focus on advancing precision medicine to assess the feasibility and cost-effectiveness of nationwide implementation across diverse sub-populations within the context of integrated screening, ensuring efficient and tailored public nutrition strategy delivery.
在中国高血压患者一级预防中，考虑叶酸补充剂掩盖维生素B12（B12）缺乏的副作用后，确定四种相关政策选项的成本效益。
成本效益分析。
考虑了四项政策：政策A，对有中风风险的高血压患者的叶酸状况不采取任何措施；政策B，补充叶酸但不预先筛查维生素B12缺乏；政策C，补充叶酸并对所有患者预先筛查B12缺乏，若B12缺乏则添加B12补充剂；政策D，仅对叶酸缺乏者补充叶酸，对所有患者预先筛查B12和叶酸缺乏，若B12缺乏则添加B12补充剂。从中国医疗保健系统角度出发，基于中国脑卒中一级预防试验（CSPPT）构建了一个为期五年的干预决策树，估计了政策B、政策C和政策D相对于政策A的增量成本效益比（ICER）。
在支付意愿（WTP）阈值为全国人均GDP的3倍（38,198美元）时，与政策A相比，政策B不具有成本效益，由于B12缺乏的延迟诊断导致的QALY损失以及与治疗神经病变相关的潜在成本低估，其ICER为每QALY 47,968美元。然而，与政策A相比，政策C和政策D具有成本效益，ICER分别为每QALY 32,615美元和20,287美元。概率敏感性分析表明，与政策A相比，政策C和政策D的额外成本处于或低于WTP阈值的概率分别为72.7%和83.5%。
在中国高血压老年患者一级预防中，补充叶酸并综合筛查B12和叶酸缺乏被认为是最具成本效益的策略。未来的研究应侧重于推进精准医学，以评估在综合筛查背景下在不同亚人群中全国范围内实施的可行性和成本效益，确保高效且量身定制的公共营养策略实施。
