Daroudi Rajabali, Sari Ali Akbari, Zamandi Mahmoud, Yousefi Elham
Department of Health Management, policy and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
Center for Noncommunicble Disease Control & Prevention, Deputy of health, Ministry of Health and Medical Education, Tehran, Iran.
PLoS One. 2025 Jul 22;20(7):e0303223. doi: 10.1371/journal.pone.0303223. eCollection 2025.
Hypertension is one of the most common non-communicable diseases in the world and plays a significant role in the occurrence of cardiovascular complications, including coronary heart disease (CHD) and strokes. Therefore, the purpose of this study is to conduct an economic evaluation of high blood pressure screening strategies in Iran in 2020.
We did an economic evaluation of 9 blood pressure screening strategies, including screening annually or every two or three years from the ages of 30, 40, or 50, using the Markov model. The Markov model was designed and implemented based on the natural history of cardiovascular disease in the 2020 TreeAge Pro software. The quality-adjusted life years and the average cost of high blood pressure screening and treatment per person were estimated from society's perspective for the lifetime. Input data of the model were derived from published literature, expert opinion, and available data sources.
All screening interventions were more costly and more effective compared to no screening. Five strategies, including screening every three years from the age of 50, 40, and 30 years and screening every two years and annually from the age of 30, were undominated. Incremental cost-effectiveness ratios for these strategies ranged from $PPP 2,675.20 to 20,466.83. Probabilistic sensitivity analysis indicated that, at a cost-effectiveness threshold close to one times the GDP per capita, screening every two or three years from age 30 had the highest cost-effectiveness, with probabilities of 0.522 and 0.44, respectively.
Based on the findings of the economic evaluation, all screening strategies are more cost-effective compared to no screening, and among the screening strategies, considering about one times the GDP per capita as the cost-effectiveness threshold, a screening strategy every two years, starting at the age of 30, is the most cost-effective strategy.
高血压是世界上最常见的非传染性疾病之一，在包括冠心病（CHD）和中风在内的心血管并发症的发生中起着重要作用。因此，本研究的目的是对2020年伊朗高血压筛查策略进行经济评估。
我们使用马尔可夫模型对9种血压筛查策略进行了经济评估，包括从30岁、40岁或50岁开始每年或每两年或三年进行一次筛查。马尔可夫模型是基于2020年TreeAge Pro软件中心血管疾病的自然病史设计和实施的。从社会角度估计了每人一生的质量调整生命年以及高血压筛查和治疗的平均成本。模型的输入数据来自已发表的文献、专家意见和可用的数据源。
与不进行筛查相比，所有筛查干预措施成本更高但效果更好。五种策略未被其他策略占优，包括从50岁、40岁和30岁开始每三年进行一次筛查，以及从30岁开始每两年和每年进行一次筛查。这些策略的增量成本效益比在2675.20美元购买力平价至20466.83美元购买力平价之间。概率敏感性分析表明，在成本效益阈值接近人均国内生产总值一倍时，从30岁开始每两年或三年进行一次筛查具有最高的成本效益，概率分别为0.522和0.44。
基于经济评估的结果，与不进行筛查相比，所有筛查策略都更具成本效益，并且在筛查策略中，将人均国内生产总值一倍左右作为成本效益阈值时，从30岁开始每两年进行一次筛查的策略是最具成本效益的策略。
