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Liang W, Zhang X, Wang Q, Yu H, Yu J. Assessing the evolution of hypertension management in Gansu, China: A comparative study of prevalence, awareness, treatment, and control in 2012 and 2022. J Clin Hypertens (Greenwich) 2024; 26:674-686. [PMID: 38577938 PMCID: PMC11180686 DOI: 10.1111/jch.14809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 03/07/2024] [Accepted: 03/13/2024] [Indexed: 04/06/2024]
Abstract
The aim of this study is to evaluate the developments in the treatment and prevalence of hypertension by demographic subgroups in least developed area of China in 2012 and 2022. This population-based cross-sectional study was conducted in 2012 and 2022, we applied stratified multistage random sampling to investigate residents aged 18 years or older in Gansu, the least developed province in the northwest of China. Questionnaires and anthropometric measurements were given to all respondents. The standardized prevalence of hypertension in adults in Gansu increased from 26.1% in 2012 to 28.8% in 2022. Compared with 2012, the control rate remains decreased despite the significantly improved awareness and treatment rates of hypertension in 2022. Apart from the reversal of the control rate, the trend of higher prevalence in men and higher awareness and treatment rates in women has not changed. There was an obviously increase in the proportion of participants who had received health education and hypertension management services from medical workers. The treatment was still primarily monotherapy, and there was no significant improvement in the prescription of medication. The prevalence of hypertension has increased mildly in the least developed region of China over the past decade, and the challenge of hypertension management has shifted from increasing awareness and treatment rates to increasing control rates. The onset and control of hypertension are affected by education methods, BMI, local economic conditions and other factors, and targeted strategies can be adopted to strengthen the management of hypertension in economically underdeveloped areas of China.
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Affiliation(s)
- Wei Liang
- Department of CardiologyLanzhou University Second HospitalLanzhouChina
| | - Xiaowei Zhang
- Department of CardiologyLanzhou University Second HospitalLanzhouChina
| | - Qiongying Wang
- Department of CardiologyLanzhou University Second HospitalLanzhouChina
| | - Heng Yu
- Department of CardiologyLanzhou University Second HospitalLanzhouChina
| | - Jing Yu
- Department of CardiologyLanzhou University Second HospitalLanzhouChina
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Zhang Y, Zhu X, Gao F, Yang S. Systematic Review and Critical Appraisal of Prediction Models for Readmission in Coronary Artery Disease Patients: Assessing Current Efficacy and Future Directions. Risk Manag Healthc Policy 2024; 17:549-557. [PMID: 38496372 PMCID: PMC10944133 DOI: 10.2147/rmhp.s451436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 03/04/2024] [Indexed: 03/19/2024] Open
Abstract
Purpose Coronary artery disease (CAD) patients frequently face readmissions due to suboptimal disease management. Prediction models are pivotal for detecting early unplanned readmissions. This review offers a unified assessment, aiming to lay the groundwork for enhancing prediction models and informing prevention strategies. Methods A search through five databases (PubMed, Web of Science, EBSCOhost, Embase, China National Knowledge Infrastructure) up to September 2023 identified studies on prediction models for coronary artery disease patient readmissions for this review. Two independent reviewers used the CHARMS checklist for data extraction and the PROBAST tool for bias assessment. Results From 12,457 records, 15 studies were selected, contributing 30 models targeting various CAD patient groups (AMI, CABG, ACS) from primarily China, the USA, and Canada. Models utilized varied methods such as logistic regression and machine learning, with performance predominantly measured by the c-index. Key predictors included age, gender, and hospital stay duration. Readmission rates in the studies varied from 4.8% to 45.1%. Despite high bias risk across models, several showed notable accuracy and calibration. Conclusion The study highlights the need for thorough external validation and the use of the PROBAST tool to reduce bias in models predicting readmission for CAD patients.
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Affiliation(s)
- Yunhao Zhang
- College of Nursing, Hangzhou Normal University, Hangzhou, People’s Republic of China
| | - Xuejiao Zhu
- College of Nursing, Hangzhou Normal University, Hangzhou, People’s Republic of China
| | - Fuer Gao
- College of Nursing, Hangzhou Normal University, Hangzhou, People’s Republic of China
| | - Shulan Yang
- Department of Nursing, Zhejiang Hospital, Hangzhou, People’s Republic of China
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Zhou YF, Deng H, Wang GD, Chen S, Xing A, Wang Y, Zhao H, Gao J, Wu S. Cost-effectiveness of drug treatment for young and middle-aged stage 1 hypertensive patients with high risk. J Glob Health 2023; 13:04147. [PMID: 37997845 PMCID: PMC10668205 DOI: 10.7189/jogh.13.04147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2023] Open
Abstract
Background Drug treatment was recommended for stage 1 hypertensive patients (blood pressure of 130-139 / 80-89 millimetres of mercury (mmHg)) with high cardiovascular disease (CVD) risk in the 2017 Hypertension Clinical Practice Guidelines, 2018 Chinese guidelines and 2021 World Health Organization guidelines, but not in other guidelines. However, evidence on the cost-effectiveness of drug treatment among young and middle-aged patients remains scarce. This study aimed to compare the cost-effectiveness of drug treatment vs. non-drug treatment for stage 1 hypertensive patients aged <60 years with high CVD risk. Methods A microsimulation model projected quality-adjusted life years (QALYs), health care costs, and incremental cost-effectiveness ratios for drug treatment from a societal perspective. Transition probabilities were estimated from the Kailuan study with a sample size of 34 093 patients aged <60 years with high CVD risk. Costs and health utilities were obtained from the Kailuan study, national statistics reports and published literature. Results Over a 15-year time horizon, the model predicted that drug treatment generated QALY of 9.36 and was associated with expected costs of 3735 US dollars ($) compared with 9.07 and $3923 produced by non-drug treatment among stage 1 hypertensive patients, resulting in a cost-saving for drug treatment. At a willingness-to-pay threshold of $10439/QALY (one gross domestic product (GDP) per capita in 2020), drug treatment had a 99.99% probability of being cost-effective for 10 000 samples of probabilistic sensitivity analysis. Sensitivity analyses by different values of transition probability, cost, utility and discount rate did not appreciably change the results. Shortening the time horizon to the average follow-up period of eight years resulted in ICER of $189/QALY for drug treatment (<1 × GDP/QALY). Conclusions Our results suggested that drug treatment was a dominant strategy for stage 1 hypertensive patients aged <60 years with high CVD risk in China, which may provide evidence for policymakers and clinicians when weighing the pros and cons of drug treatment for young and middle-aged stage 1 hypertensive patients.
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Affiliation(s)
- Yan-Feng Zhou
- Department of Social Medicine, School of Public Health, Guangxi Medical University, Nanning, China
| | - Hua Deng
- Department of Nephrology, The First People's Hospital of Chenzhou, Chenzhou, China
| | - Guo-Dong Wang
- Department of Cardiology, Kailuan General Hospital, Tangshan, China
| | - Shuohua Chen
- Department of Cardiology, Kailuan General Hospital, Tangshan, China
| | - Aijun Xing
- Department of Cardiology, Kailuan General Hospital, Tangshan, China
| | - Yanxiu Wang
- Department of Cardiology, Kailuan General Hospital, Tangshan, China
| | - Haiyan Zhao
- Department of Cardiology, Kailuan General Hospital, Tangshan, China
| | - Jingli Gao
- Department of Intensive Care Unit, Kailuan General Hospital, Tangshan, China
| | - Shouling Wu
- Department of Cardiology, Kailuan General Hospital, Tangshan, China
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Liao CT, Toh HS, Sun L, Yang CT, Hu A, Wei D, Melgarejo J, Zhang ZY. Cost-effectiveness of Intensive vs Standard Blood Pressure Control Among Older Patients With Hypertension. JAMA Netw Open 2023; 6:e230708. [PMID: 36848091 PMCID: PMC9972197 DOI: 10.1001/jamanetworkopen.2023.0708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/01/2023] Open
Abstract
IMPORTANCE Older patients with hypertension receiving intensive systolic blood pressure control (110-130 mm Hg) have lower incidences of cardiovascular events than those receiving standard control (130-150 mm Hg). Nevertheless, the mortality reduction is insignificant, and intensive blood pressure management results in more medical costs from treatments and subsequent adverse events. OBJECTIVE To examine the incremental lifetime outcomes, costs, and cost-effectiveness of intensive vs standard blood pressure control in older patients with hypertension from the health care payer's perspective. DESIGN, SETTING, AND PARTICIPANTS This economic analysis was conducted with a Markov model to examine the cost-effectiveness of intensive blood pressure management among patients aged 60 to 80 years with hypertension. Treatment outcome data from the Trial of Intensive Blood-Pressure Control in Older Patients With Hypertension (STEP trial) and different cardiovascular risk assessment models for a hypothetical cohort of STEP-eligible patients were used. Costs and utilities were obtained from published sources. The incremental cost-effectiveness ratio (ICER) against the willingness-to-pay threshold was used to evaluate whether the management was cost-effective. Extensive sensitivity, subgroup, and scenario analyses were performed to address uncertainty. The US and UK population using race-specific cardiovascular risk models were conducted in the generalizability analysis. Data for the STEP trial were collected from February 10 to March 10, 2022, and were analyzed for the present study from March 10 to May 15, 2022. INTERVENTIONS Hypertension treatments with a systolic blood pressure target of 110 to 130 mm Hg or 130 to 150 mm Hg. MAIN OUTCOMES AND MEASURES Incremental lifetime quality-adjusted life-years (QALYs), costs, and ICER are discounted at the given rates annually. RESULTS After simulating 10 000 STEP-eligible patients assumed to be 66 years of age (4650 men [46.5%] and 5350 women [53.5%]) in the model, the ICER values were ¥51 675 ($12 362) per QALY gained in China, $25 417 per QALY gained in the US, and £4679 ($7004) per QALY gained in the UK. Simulations projected that the intensive management in China being cost-effective were 94.3% and 100% below the willingness-to-pay thresholds of 1 time (¥89 300 [$21 364]/QALY) and 3 times (¥267 900 [$64 090]/QALY) the gross domestic product per capita, respectively. The US had 86.9% and 95.6% probabilities of cost-effectiveness at $50 000/QALY and $100 000/QALY, respectively, and the UK had 99.1% and 100% of probabilities of cost-effectiveness at £20 000 ($29 940)/QALY and £30 000 ($44 910)/QALY, respectively. CONCLUSIONS AND RELEVANCE In this economic evaluation, the intensive systolic blood pressure control in older patients produced fewer cardiovascular events and had acceptable costs per QALY gained, well below the typical willingness-to-pay thresholds. The cost-effective advantages of intensive blood pressure management in older patients were consistent over various clinical scenarios across different countries.
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Affiliation(s)
- Chia-Te Liao
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan City, Taiwan
- Division of Cardiology, Department of Internal Medicine, Chi Mei Medical Center, Tainan City, Taiwan
| | - Han Siong Toh
- Department of Intensive Care Medicine, Chi Mei Medical Center, Tainan City, Taiwan
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan City, Taiwan
- Department of Health and Nutrition, Chia Nan University of Pharmacy and Science, Tainan City, Taiwan
| | - Li Sun
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Chun-Ting Yang
- Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan City, Taiwan
| | - Angie Hu
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Dongmei Wei
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Jesus Melgarejo
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Zhen-Yu Zhang
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
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Pang L, Kottu L, Guo Z, Shi Y, Ferdous M, Zhao Y, Tang M, Liu W, Fang J, Fu H, Wu X, Ma M, Wang H, Merkus D, Duo L. Dawning public health services dogma: An indigenous Southwest Chinese perspective in managing hypertension-with or without the "BPHS"? Front Public Health 2022; 10:1017795. [PMID: 36438225 PMCID: PMC9686286 DOI: 10.3389/fpubh.2022.1017795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 10/26/2022] [Indexed: 11/11/2022] Open
Abstract
Background To alleviate the rising mortality burden due to hypertension and other non-communicable diseases, a new public health policy initiative in 2009 called the Basic Public Health Services (BPHS). Program was introduced by the Chinese government. The goal of the study is to assess the feasibility and impact of a nationwide health care service-the "BPHS". Methods From January to December 2021, a stratified multistage random sampling method in the survey was conducted to select 6,456 people from 8 cities/districts in Yunnan Province, China, who were above the age of 35 years. 1,521 hypertensive patients were previously aware of their high blood pressure status were matched to the BPHS program database based on ID number and then further divided into BPHS group and non-BPHS (control) group. The results of the current study are based on their responses to a short structured questionnaire, a physical examination, and laboratory tests. The association between BPHS management and its effect on the control of hypertension was estimated using multivariable logistic regression models. We evaluated the accessibility and efficacy of BPHS health care services by analyzing various variables such as blood pressure, BMI, lifestyle modification, anti-hypertensive drugs taken, and cardiovascular risk factors. Results Among the 1,521 hypertensive patients included in this study, 1,011 (66.5%) were managed by BPHS programme. The multivariable logistic regression model demonstrated that the BPHS facilitated hypertension control (OR = 1.640, 95% CI: 1.237-2.175). A higher proportion of participants receiving lifestyle guidance from the BPHS management showed lowering of total cholesterol. In comparison to the non-BPHS group, those under BPHS management adhered better to antihypertensive medications either single drug (54.3%) or in combination (17.3%) of drugs. Additionally, we also noticed that urban areas with centralized and well-established digital information management system had better hypertension treatment and control. Conclusions Nearly two-thirds of the hypertensive patients in Yunnan Province were included in BPHS management. The impact of the national BPHS program was evident in lowering risk factors for cardiovascular diseases, promoting healthy lifestyles, lowering blood pressure, increasing medication adherence, and the better control rate of hypertension.
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Affiliation(s)
- Linhong Pang
- Affiliated Cardiovascular Hospital of Kunming Medical University, Fuwai Yunnan Cardiovascular Hospital, Kunming, China,School of Public Health, Kunming Medical University, Kunming, China
| | - Lakshme Kottu
- Division of Experimental Cardiology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Zihong Guo
- Affiliated Cardiovascular Hospital of Kunming Medical University, Fuwai Yunnan Cardiovascular Hospital, Kunming, China
| | - Yi Shi
- Affiliated Cardiovascular Hospital of Kunming Medical University, Fuwai Yunnan Cardiovascular Hospital, Kunming, China
| | - Misbahul Ferdous
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yajing Zhao
- Affiliated Cardiovascular Hospital of Kunming Medical University, Fuwai Yunnan Cardiovascular Hospital, Kunming, China
| | - Mingjing Tang
- Affiliated Cardiovascular Hospital of Kunming Medical University, Fuwai Yunnan Cardiovascular Hospital, Kunming, China
| | - Wei Liu
- School of Public Health, Kunming Medical University, Kunming, China
| | - Jiayu Fang
- School of Public Health, Kunming Medical University, Kunming, China
| | - Hongchen Fu
- School of Public Health, Kunming Medical University, Kunming, China
| | - Xia Wu
- School of Public Health, Kunming Medical University, Kunming, China
| | - Min Ma
- School of Public Health, Kunming Medical University, Kunming, China
| | - Huadan Wang
- School of Public Health, Kunming Medical University, Kunming, China
| | - Daphne Merkus
- Division of Experimental Cardiology, Erasmus University Medical Center, Rotterdam, Netherlands,Walter Brendel Center of Experimental Medicine (WBex), LMU Munich, Munich, Germany
| | - Lin Duo
- Affiliated Cardiovascular Hospital of Kunming Medical University, Fuwai Yunnan Cardiovascular Hospital, Kunming, China,*Correspondence: Lin Duo
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Fan J, Zheng W, Liu W, Xu J, Zhou L, Liu S, Bai J, Qi Y, Huang W, Liu K, Cai J. Cost-Effectiveness of Intensive Versus Standard Blood Pressure Treatment in Older Patients With Hypertension in China. Hypertension 2022; 79:2631-2641. [DOI: 10.1161/hypertensionaha.122.20051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
In the STEP trial (Strategy of Blood Pressure Intervention in older Hypertensive Patients), the risk of cardiovascular events is significantly lower in patients who received intensive systolic blood psressure (BP) treatment than in those who received standard treatment. This study compared the lifetime health benefits and medical costs of intensive BP treatment with those of standard BP treatment.
Methods:
A microsimulation model included 10 000 hypothetical samples of Chinese adults aged 60 to 80 years old with baseline systolic BP higher than 140 mm Hg. Primary outcome was the incremental cost-effectiveness ratio from a payer’s perspective. Secondary outcome was cardiovascular events, including acute coronary syndrome, stroke, acute decompensated heart failure, atrial fibrillation, and death from cardiovascular causes.
Results:
The model simulated that cardiovascular events occurred in 36.88% of the patients in the intensive treatment group, as compared to 41.28% of the patients in the standard treatment group over the lifetime horizon. The mean number of quality-adjusted life-years would be 0.16 higher in patients who received intensive treatment than in those who received standard treatment and would cost Chinese yuan 12 614 (International dollars 3018) more per quality-adjusted life-year gained. Most simulation results indicated that intensive treatment would be cost-effective (82%–95% below the willingness-to-pay threshold of Chinese yuan 72 000 [1× the gross domestic product per capita in China in 2020]). Sensitivity analyses showed that these conclusions were robust.
Conclusions:
In this study, intensive BP treatment prevented cardiovascular events among older patients with hypertension in China and was cost-effective in most scenarios.
Registration:
URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT03015311
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Affiliation(s)
- Jiali Fan
- Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China (J.F., J.B., J.C.)
| | - Wanji Zheng
- School of Health Management, Harbin Medical University, China (W.Z., J.X., L.Z., W.H.)
| | - Wei Liu
- Department of Cardiology, Beijing Jishuitan Hospital, Peking University Fourth Hospital, China (W.L.)
| | - Juan Xu
- School of Health Management, Harbin Medical University, China (W.Z., J.X., L.Z., W.H.)
| | - Lan Zhou
- School of Health Management, Harbin Medical University, China (W.Z., J.X., L.Z., W.H.)
| | - Shihe Liu
- Department of Cardiology, Kailuan General Hospital, Tangshan, China (S.L.)
| | - Jingjing Bai
- Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China (J.F., J.B., J.C.)
| | - Yue Qi
- Department of Epidemiology, Beijing An Zhen Hospital, Capital Medical University, China (Y.Q.)
| | - Weidong Huang
- School of Health Management, Harbin Medical University, China (W.Z., J.X., L.Z., W.H.)
| | - Kejun Liu
- China National Health Development Research Center, Beijing (K.L.)
| | - Jun Cai
- Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China (J.F., J.B., J.C.)
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Lee YS, Lee HY, Kim TH. An economic evaluation of intensive hypertension control in CKD patients: a cost-effectiveness study. Clin Hypertens 2022; 28:32. [PMID: 36316765 PMCID: PMC9623905 DOI: 10.1186/s40885-022-00215-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 06/08/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Studies have suggested that intensive hypertension control in patients with a high risk of cardiovascular disease (CVD) is both effective and economically feasible. The purpose of this study is to conduct an economic evaluation of intensive hypertension control targeting chronic kidney disease (CKD) patients using the representative data in Korea. METHODS We used a Markov decision model to compare both cost and effectiveness of intensive hypertension control versus standard hypertension control in hypertensive CKD patients. Model parameters were estimated with the data from the National Health Insurance Service (NHIS)-National Sample Cohort, as well as latest literature. One-way sensitivity analysis was conducted to test the effect of variation in key parameters on the model outcome. RESULTS For CKD patients with hypertension, intensive hypertension control would cost more but increase utilities, compared to standard hypertension control. The incremental cost-effectiveness ratio (ICER) for intensive hypertension control in CKD patients was projected at 18,126 USDs per quality-adjusted life year (QALY) compared to standard hypertension control. The results of sensitivity analysis suggest that the results are overall robust. CONCLUSIONS This study finds that intensive hypertension control in CKD patients in Korea is economically sound. This information is expected to be useful for clinicians in managing hypertension of CKD patients and policymakers when making decisions.
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Affiliation(s)
- Ye Seol Lee
- grid.31501.360000 0004 0470 5905Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea ,National Traffic Injury Rehabilitation Research Institute, National Traffic Injury Rehabilitation Hospital, Yangpyeong, Republic of Korea
| | - Hae-Young Lee
- grid.31501.360000 0004 0470 5905Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Tae Hyun Kim
- grid.15444.300000 0004 0470 5454Department of Healthcare Management, Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea
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Cost-effectiveness of folic acid therapy for primary prevention of stroke in patients with hypertension. BMC Med 2022; 20:407. [PMID: 36280851 PMCID: PMC9594871 DOI: 10.1186/s12916-022-02601-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 10/11/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND For hypertensive patients without a history of stroke or myocardial infarction (MI), the China Stroke Primary Prevention Trial (CSPPT) demonstrated that treatment with enalapril-folic acid reduced the risk of primary stroke compared with enalapril alone. Whether folic acid therapy is an affordable and beneficial treatment strategy for the primary prevention of stroke in hypertensive patients from the Chinese healthcare sector perspective has not been thoroughly explored. METHODS We performed a cost-effectiveness analysis alongside the CSPPT, which randomized 20,702 hypertensive patients. A patient-level microsimulation model based on the 4.5-year period of in-trial data was used to estimate costs, life years, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs) for enalapril-folic acid vs. enalapril over a lifetime horizon from the payer perspective. RESULTS During the in-trial follow-up period, patients receiving enalapril-folic acid gained an average of 0.016 QALYs related primarily to reductions in stroke, and the incremental cost was $706.03 (4553.92 RMB). Over a lifetime horizon, enalapril-folic acid treatment was projected to increase quality-adjusted life years by 0.06 QALYs or 0.03 life-year relative to enalapril alone at an incremental cost of $1633.84 (10,538.27 RMB), resulting in an ICER for enalapril-folic acid compared with enalapril alone of $26,066.13 (168,126.54 RMB) per QALY gained and $61,770.73 (398,421.21 RMB) per life-year gained, respectively. A probabilistic sensitivity analysis demonstrated that enalapril-folic acid compared with enalapril would be economically attractive in 74.5% of simulations at a threshold of $37,663 (242,9281 RMB) per QALY (3x current Chinese per capita GDP). Several high-risk subgroups had highly favorable ICERs < $12,554 (80,976 RMB) per QALY (1x GDP). CONCLUSIONS For both in-trial and over a lifetime, it appears that enalapril-folic acid is a clinically and economically attractive medication compared with enalapril alone. Adding folic acid to enalapril may be a cost-effective strategy for the prevention of primary stroke in hypertensive patients from the Chinese health system perspective.
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Hirashiki A, Shimizu A, Nomoto K, Kokubo M, Suzuki N, Arai H. Systematic Review of the Effectiveness of Community Intervention and Health Promotion Programs for the Prevention of Non-Communicable Diseases in Japan and Other East and Southeast Asian Countries. Circ Rep 2022; 4:149-157. [PMID: 35434409 PMCID: PMC8977194 DOI: 10.1253/circrep.cr-21-0165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/27/2022] [Accepted: 03/10/2022] [Indexed: 11/09/2022] Open
Abstract
Background: Non-communicable diseases (NCDs) are the leading cause of death worldwide. However, current evidence regarding the efficacy and cost-effectiveness of community intervention and health promotion programs for NCDs, specifically hypertension, obesity, diabetes, and dyslipidemia, in East and Southeast Asia has not yet been systematically reviewed. We systematically reviewed the literature from East and Southeast Asian countries to answer 2 clinical questions: (1) do health promotion programs for hypertension, obesity, diabetes, and dyslipidemia reduce cardiovascular events and mortality; and (2) are these programs cost-effective? Methods and Results: Electronic literature searches were performed across Medline, Cochrane Library, and Ichushi using key words and relevant subject headings related to randomized controlled trials, comparative studies, quasi-experimental studies, or propensity score matching that met eligibility criteria that were defined for each question. In all, 3,389 records were identified, of which 12 full-text articles were reviewed. Three papers were from Japan, 7 were from China/Hong Kong Special Administrative Region, and 2 were from South Korea. None were from Southeast Asia. Four papers examined the effect of community intervention or health promotion on the incidence of cardiovascular events or mortality. Eight studies examined the cost-effectiveness of interventions. Conclusions: The literature review revealed that community intervention and health promotion programs for the control of NCDs are a cost-effective means of reducing cardiovascular events and mortality in East Asian countries.
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Affiliation(s)
- Akihiro Hirashiki
- Department of Cardiology, National Center for Geriatrics and Gerontology
| | - Atsuya Shimizu
- Department of Cardiology, National Center for Geriatrics and Gerontology
| | - Kenichiro Nomoto
- Department of Cardiology, National Center for Geriatrics and Gerontology
| | - Manabu Kokubo
- Department of Cardiology, National Center for Geriatrics and Gerontology
| | - Noriyuki Suzuki
- Department of Cardiology, National Center for Geriatrics and Gerontology
| | - Hidenori Arai
- Department of Geriatric Medicine, National Center for Geriatrics and Gerontology
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Zhou X, Li S, Li L, Deng G, Dai L, Chai L, Wu Q, Yao Z, Deng M, Zhu W, Fu Y, Sun X. Community-based heat-sensitive moxibustion for primary hypertension: study protocol for a randomized controlled trial with patient-preference arms. Trials 2022; 23:154. [PMID: 35172871 PMCID: PMC8848640 DOI: 10.1186/s13063-022-06092-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 02/07/2022] [Indexed: 02/08/2023] Open
Abstract
Background Low- and middle-income countries have a high prevalence of primary hypertension, but its treatment and control are often low. Heat-sensitive moxibustion (HSM), an innovative acupoint stimulation technique, may be effective for treating hypertension and thus used appropriately in primary healthcare. The objective of this study is to investigate whether HSM is effective and safe for the treatment of primary hypertension in the community. Methods This study is a multicenter, pragmatic, randomized controlled trial (RCT) with patient-preference arms. Four hundred patients with primary hypertension from seven communities will be enrolled. Initially, the communities will be randomly assigned into two study clusters, one using compulsory randomization and the other allowing treatment selection by patient preferences. Then, patients in the compulsory randomization cluster will be randomized to receive HSM plus their original antihypertensive regimen (HSM group) or only their original antihypertensive regimen (control group) for 6 months. Patients in the patient preference cluster may choose to receive HSM or control if they have a preference; otherwise, patients will be randomly assigned. The primary outcome is the change in systolic blood pressure from baseline; secondary outcomes include change in diastolic blood pressure, dosage of antihypertensive drugs, quality of life (QoL), severity of hypertensive symptoms, and incidence of cardiovascular events. Patient compliance with the HSM regimen, the cost-effectiveness ratio, and safety outcomes will also be evaluated. Outcome data will be collected at 6 monthly visits. Discussion This trial will provide important evidence regarding HSM as a technique for primary hypertension in primary healthcare settings. Given the randomization with patient preferences considered, the trial will also allow analyzing patient-preference effects and the comparison of randomized and nonrandomized samples, to improve the robustness and extrapolation of study conclusions. Trial registration ClinicalTrials.govNCT04788563. Registered on March 9, 2021. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06092-4.
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Affiliation(s)
- Xu Zhou
- Evidence-based Medicine Research Center, Jiangxi University of Chinese Medicine, Nanchang City, Jiangxi, China
| | - Shuqing Li
- Evidence-based Medicine Research Center, Jiangxi University of Chinese Medicine, Nanchang City, Jiangxi, China
| | - Ling Li
- Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, Guo Xue Xiang No.37, Chengdu City, 610041, Sichuan, China
| | - Guihua Deng
- First Department of Acupuncture and Moxibustion, The Affiliated Hospital of Jiangxi University of Chinese Medicine, Bayi Avenue No.445, Nanchang City, 330006, Jiangxi, China
| | - Li Dai
- First Department of Acupuncture and Moxibustion, The Affiliated Hospital of Jiangxi University of Chinese Medicine, Bayi Avenue No.445, Nanchang City, 330006, Jiangxi, China
| | - Luyu Chai
- First Department of Acupuncture and Moxibustion, The Affiliated Hospital of Jiangxi University of Chinese Medicine, Bayi Avenue No.445, Nanchang City, 330006, Jiangxi, China
| | - Qingni Wu
- Evidence-based Medicine Research Center, Jiangxi University of Chinese Medicine, Nanchang City, Jiangxi, China
| | - Ziqian Yao
- First Department of Acupuncture and Moxibustion, The Affiliated Hospital of Jiangxi University of Chinese Medicine, Bayi Avenue No.445, Nanchang City, 330006, Jiangxi, China
| | - Minchao Deng
- First Department of Acupuncture and Moxibustion, The Affiliated Hospital of Jiangxi University of Chinese Medicine, Bayi Avenue No.445, Nanchang City, 330006, Jiangxi, China
| | - Weifeng Zhu
- Evidence-based Medicine Research Center, Jiangxi University of Chinese Medicine, Nanchang City, Jiangxi, China
| | - Yong Fu
- First Department of Acupuncture and Moxibustion, The Affiliated Hospital of Jiangxi University of Chinese Medicine, Bayi Avenue No.445, Nanchang City, 330006, Jiangxi, China.
| | - Xin Sun
- Evidence-based Medicine Research Center, Jiangxi University of Chinese Medicine, Nanchang City, Jiangxi, China. .,Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, Guo Xue Xiang No.37, Chengdu City, 610041, Sichuan, China.
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11
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Ke X, Zhang L, Tang W. Cost-Utility Analysis of the Integrated Care Models for the Management of Hypertension Patients: A Quasi-Experiment in Southwest Rural China. Front Public Health 2021; 9:727829. [PMID: 34966712 PMCID: PMC8710505 DOI: 10.3389/fpubh.2021.727829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 11/10/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Hypertension has become the second-leading risk factor for death worldwide. However, the fragmented three-level “county–township–village” medical and healthcare system in rural China cannot provide continuous, coordinated, and comprehensive health care for patients with hypertension, as a result of which rural China has a low rate of hypertension control. This study aimed to explore the costs and benefits of an integrated care model using three intervention modes—multidisciplinary teams (MDT), multi-institutional pathway (MIP), and system global budget and performance-based payments (SGB-P4P)—for hypertension management in rural China. Methods: A Markov model with 1-year per cycle was adopted to simulate the lifetime medical costs and quality-adjusted life-years (QALYs) for patients. The interventions included Option 1 (MDT + MIP), Option 2 (MDT + MIP + SGB–P4P), and the Usual practice (usual care). We used the incremental cost-effectiveness ratio (ICER), net monetary benefit (NMB), and net health benefit (NHB) to make economic decisions and a 5% discount rate. One-way and probability sensitivity analyses were performed to test model robustness. Data on the blood pressure control rate, transition probability, utility, annual treatment costs, and project costs were from the community intervention trial (CMB-OC) project. Results: Compared with the Usual practice, Option 1 yielded an additional 0.068 QALYs and an additional cost of $229.99, resulting in an ICER of $3,373.75/QALY, the NMB was –$120.97, and the NHB was −0.076 QALYs. Compared with the Usual practice, Option 2 yielded an additional 0.545 QALYs, and the cost decreased by $2,007.31, yielding an ICER of –$3,680.72/QALY. The NMB was $2,879.42, and the NHB was 1.801 QALYs. Compared with Option 1, Option 2 yielded an additional 0.477 QALYs, and the cost decreased by $2,237.30, so the ICER was –$4,688.50/QALY, the NMB was $3,000.40, and the NHB was 1.876 QALYs. The one-way sensitivity analysis showed that the most sensitive factors in the model were treatment cost of ESRD, human cost, and discount rate. The probability sensitivity analysis showed that when willingness to pay was $1,599.16/QALY, the cost-effectiveness probability of Option 1, Option 2, and the Usual practice was 0.008, 0.813, and 0.179, respectively. Conclusions: The integrated care model with performance-based prepaid payments was the most beneficial intervention, whereas the general integrated care model (MDT + MIP) was not cost-effective. The integrated care model (MDT + MIP + SGB-P4P) was suggested for use in the community management of hypertension in rural China as a continuous, patient-centered care system to improve the efficiency of hypertension management.
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Affiliation(s)
- Xiatong Ke
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, China.,Center for Pharmacoeconomics and Outcomes Research of China Pharmaceutical University, Nanjing, China
| | - Liang Zhang
- School of Medical and Health Management, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China.,Research Center for Rural Health Services, Hubei Province Key Research Institute of Humanities and Social Sciences, Wuhan, China
| | - Wenxi Tang
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, China.,Center for Pharmacoeconomics and Outcomes Research of China Pharmaceutical University, Nanjing, China
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12
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Lee YS, Lee HY, Kim TH. Cost-effectiveness analysis of intensive blood pressure control in Korea. Hypertens Res 2021; 45:507-515. [PMID: 34934160 DOI: 10.1038/s41440-021-00774-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 08/10/2021] [Accepted: 09/04/2021] [Indexed: 01/09/2023]
Abstract
This study was a cost-effectiveness analysis of intensive blood pressure (BP) control among hypertensive patients in Korea. We constructed a Markov model comparing intensive versus standard BP control treatment and calculated the incremental cost-effectiveness ratio. The study population consisted of hypertensive patients over 50 years old with systolic blood pressures (SBPs) exceeding 140 mmHg and at high risk of cardiovascular disease. Treatment alternatives included lowering the SBP below 120 mmHg (intensive) and 140 mmHg (standard) for target BP. We assumed five scenarios with different medication adherence. The effectiveness variable was quality-adjusted life years (QALYs), and costs included medical costs related to hypertension (HT), complications, and nonmedical costs. In addition, we performed a sensitivity analysis to confirm the robustness of the results of this study. Scenario 5, with 100% medication adherence, showed the lowest incremental cost-effectiveness ratio (ICER) of $1,373 USD, followed by scenario 1 (first 15 years: 62.5%, 16-30 years: 65.2%, after 30 years: 59.5%), scenario 2 (first five years: 62.5% decrease by 5% every five years), and scenario 3 (first 10 years: 62.5% decrease by 10% every 10 years). The ICERs in all scenarios were lower than the willingness to pay (WTP) threshold of $9,492-$32,907 USD in Korea. Tornado analysis showed that the ICERs were changed greatly according to stroke incidence. Intensive treatment of HT prevents cardiovascular disease (CVD); therefore, intensive treatment is more cost-effective than standard treatment despite the consumption of more health resources. ICERs are considerably changed according to medication adherence, confirming the importance of patient adherence to treatment.
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Affiliation(s)
- Ye Seol Lee
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.,National Traffic Injury Rehabilitation Research Institute, National Traffic Injury Rehabilitation Hospital, Yangpyeong, Republic of Korea
| | - Hae-Young Lee
- Department of Internal Medicine, Division of Cardiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Tae Hyun Kim
- Department of Healthcare Management, Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea.
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13
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Toward the Development of Personalized Syndrome Discriminant Systems: A Discriminant System for Hypertension with Liver Yang Hyperactivity Syndrome. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2021:4532279. [PMID: 34819981 PMCID: PMC8608503 DOI: 10.1155/2021/4532279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 10/23/2021] [Indexed: 11/17/2022]
Abstract
Traditional Chinese medicine has shown promising results in treating the symptoms of hypertension, a major global health concern not yet fully managed by modern medicine. It is, therefore, of high priority to clarify the altered pathophysiology of hypertension in individuals with liver Yang hyperactivity syndrome (HLYH) in response to effective treatments to better understand this disorder. The primary aim of this study was to construct a personalized syndrome discriminant system based on data capable of informing management strategies prior to the initiation of antihypertensive therapy or the implementation of screening strategies in at-risk HLYH. Based on the successful replication of HLYH rat models, we extracted the core discriminant factors of the disorder through the integration of physical signs, biochemical indicators, and metabolic markers. Macro and micro information was correlated to construct a syndrome discriminant system. At the macroscopic level, HLYH rat models characterized by elevated blood pressure were found to be associated with significant changes in water intake, pain threshold, retention time on a rotating platform, and body surface temperature. A total of 27 potential biomarkers and 14 metabolic pathways appeared to reflect the primary metabolic characteristics. Through the integration of these data, we successfully constructed a combined macro-micro personalized syndrome discriminant system, which provides a foundation for research regarding the risk loci of HLYH. Our findings also broaden our understanding of the biological pathways involved in HLYH.
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14
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Liu S, Yuan H, Jiang C, Xu J, Qiu X, Luo J. The blood pressure control and arteriosclerotic cardiovascular risk among Chinese community hypertensive patients. Sci Rep 2021; 11:19066. [PMID: 34561523 PMCID: PMC8463712 DOI: 10.1038/s41598-021-98745-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 09/14/2021] [Indexed: 12/04/2022] Open
Abstract
The present study aimed to describe the blood pressure (BP) control rate and 10-years arteriosclerotic cardiovascular disease (ASCVD) risk estimation among community hypertensive patients. A total of 196,803 subjects were enrolled. The control rates calculated as the intensive (SBP < 130 mmHg and DBP < 80 mmHg) and standard (SBP < 140 mmHg and DBP < 90 mmHg) threshold. Multivariable logistic analysis was employed to assess the associations between cardiovascular factors and BP control. Sensitivity, specificity and Youden’s index were used to identify the ability of high risk of ASCVD estimation by different thresholds. The control rate was 16.34% and 50.25% by the intensive and standard threshold, respectively. Besides regular medication, the risk factors for BP control included older age, male, unhealthy lifestyle, obesity, dyslipidemia and abnormal FPG. 25.08% of subjects had high risk of 10-years ASCVD estimation. The sensitivity, specificity and Youden’s index of intensive threshold was 84.37%, 16.15% and 0.51%, and were significantly different from 50.55%, 50.42% and 0.98% of the standard threshold, respectively. Half of community hypertensive patients did not control BP, and nearly a quarter have high risk of 10-years ASCVD risk estimation. The intensive threshold resulted in a one-third reduction in the control rate compared to the standard threshold. No matter which threshold was used, a single BP control status seemed not a suitable indicator for identification of high risk of 10-years ASCVD risk estimation.
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Affiliation(s)
- Shijun Liu
- Department of Chronic and Non-Infection Disease Control and Prevention, Hangzhou Center for Disease Control and Prevention, Mingshi Road No.568, Hangzhou, 310021, China.
| | - Hanyan Yuan
- Gongshu District Center for Disease Control and Prevention, Hangzhou, China
| | - Caixia Jiang
- Department of Chronic and Non-Infection Disease Control and Prevention, Hangzhou Center for Disease Control and Prevention, Mingshi Road No.568, Hangzhou, 310021, China
| | - Jue Xu
- Department of Chronic and Non-Infection Disease Control and Prevention, Hangzhou Center for Disease Control and Prevention, Mingshi Road No.568, Hangzhou, 310021, China
| | - Xin Qiu
- Department of Chronic and Non-Infection Disease Control and Prevention, Hangzhou Center for Disease Control and Prevention, Mingshi Road No.568, Hangzhou, 310021, China
| | - Jun Luo
- Department of Chronic and Non-Infection Disease Control and Prevention, Hangzhou Center for Disease Control and Prevention, Mingshi Road No.568, Hangzhou, 310021, China
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15
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The Rates and the Determinants of Hypertension According to the 2017 Definition of Hypertension by ACC/AHA and 2014 Evidence-Based Guidelines Among Population Aged ≥40 Years Old. Glob Heart 2021; 16:34. [PMID: 34040947 PMCID: PMC8103848 DOI: 10.5334/gh.914] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background: In November 2017, the American College of Cardiology/American Heart Association (ACC/AHA) updated their definition of hypertension from 140/90 mm Hg to 130/80 mm Hg. Objectives: We sought to assess the situation of hypertension and the impact of applying the new threshold to a geographically and ethnically diverse population. Methods: We analyzed selected data on 237,142 participants aged ≥40 who had blood pressure taken for the 2014 China National Stroke Screening and Prevention Project. Choropleth maps and logistic regression analyses were performed to estimate the prevalence, geographical distribution and risk factors of hypertension using both 2017 ACC/AHA guidelines and 2014 evidence-based guidelines. Results: The present cross-sectional study showed the age- and sex-standardized prevalence of hypertension was 37.08% and 58.52%, respectively, according to 2014 evidence-based guidelines and 2017 ACC/AHA guidelines. The distribution of hypertension and risk factors changed little between guidelines, with data showing a high prevalence of hypertension around Bohai Gulf and in south central coastal areas using either definition. The age- and sex-standardized prevalence of newly labeled as hypertensive was 21.44%. Interestingly, the high prevalence region of newly labeled as hypertensive was found in the north China. Conclusion: The prevalence of hypertension increased significantly on 2017 ACC/AHA guidelines compared to the prevalence when using 2014 evidence-based guidelines, with high prevalence areas of newly labeled as hypertensive now seen mainly in north China. There need to be correspondingly robust efforts to improve health education, health management, and behavioral and lifestyle interventions in the north.
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16
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Kostova D, Spencer G, Moran AE, Cobb LK, Husain MJ, Datta BK, Matsushita K, Nugent R. The cost-effectiveness of hypertension management in low-income and middle-income countries: a review. BMJ Glob Health 2020; 5:e002213. [PMID: 32912853 PMCID: PMC7484861 DOI: 10.1136/bmjgh-2019-002213] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 05/31/2020] [Accepted: 06/15/2020] [Indexed: 01/11/2023] Open
Abstract
Hypertension in low-income and middle-income countries (LMICs) is largely undiagnosed and uncontrolled, representing an untapped opportunity for public health improvement. Implementation of hypertension control strategies in low-resource settings depends in large part on cost considerations. However, evidence on the cost-effectiveness of hypertension interventions in LMICs is varied across geographical, clinical and evaluation contexts. We conducted a comprehensive search for published economic evaluations of hypertension treatment programmes in LMICs. The search identified 71 articles assessing a wide range of hypertension intervention designs and cost components, of which 42 studies across 15 countries reported estimates of cost-effectiveness. Although comparability of results was limited due to heterogeneity in the interventions assessed, populations studied, costs and study quality score, most interventions that reported cost per averted disability-adjusted life-year (DALY) were cost-effective, with costs per averted DALY not exceeding national income thresholds. Programme elements that may reduce cost-effectiveness included screening for hypertension at younger ages, addressing prehypertension, or treating patients at lower cardiovascular disease risk. Cost-effectiveness analysis could provide the evidence base to guide the initiation and development of hypertension programmes.
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Affiliation(s)
- Deliana Kostova
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Garrison Spencer
- Center for Global Noncommunicable Diseases, RTI International, Seattle, Washington, USA
| | - Andrew E Moran
- Resolve to Save Lives, an initiative of Vital Strategies, New York, New York, United States
- Columbia University Irving Medical Center, New York, New York, United States
| | - Laura K Cobb
- Resolve to Save Lives, an initiative of Vital Strategies, New York, New York, United States
| | - Muhammad Jami Husain
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Biplab Kumar Datta
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kunihiro Matsushita
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Rachel Nugent
- Center for Global Noncommunicable Diseases, RTI International, Seattle, Washington, USA
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17
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Zhou YF, Liu N, Wang P, Yang JJ, Song XY, Pan XF, Zhang X, He M, Li H, Gao YT, Xiang YB, Wu T, Yu D, Pan A. Cost-Effectiveness of Drug Treatment for Chinese Patients With Stage I Hypertension According to the 2017 Hypertension Clinical Practice Guidelines. Hypertension 2020; 76:750-758. [PMID: 32713271 PMCID: PMC7429361 DOI: 10.1161/hypertensionaha.119.14533] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Systolic/diastolic blood pressure of 130 to 139/80 to 89 mm Hg has been defined as stage I hypertension by the 2017 Hypertension Clinical Practice Guidelines. Drug treatment is recommended for stage I hypertensive patients aged ≥65 years without cardiovascular disease in the 2017 Hypertension Clinical Practice Guidelines but not in the 2018 Chinese guidelines. However, the cost-effectiveness of drug treatment among this subgroup of Chinese patients is unclear. This study developed a microsimulation model to compare costs and effectiveness of drug treatment and nondrug treatment for the subgroup of stage I hypertensive patients over a lifetime horizon from a government affordability perspective. Event rates of mortality and cardiovascular complications were estimated from 3 cohorts in the Chinese population. Costs and health utilities were obtained from the national statistics report and published literature. The model predicted that drug treatment generated quality-adjusted life-years of 13.52 and associated with expected costs of $6825 in comparison with 13.81 and $7328 produced by nondrug treatment over a lifetime horizon among stage I hypertensive patients aged ≥65 years without cardiovascular disease. At a willingness-to-pay threshold of $8836/quality-adjusted life-year (the GDP per capita in 2017), drug treatment only had a 1.8% probability of being cost-effective compared with nondrug treatment after 10 000 probabilistic simulations. Sensitivity analysis of treatment costs, benefits expected from treatment, health utilities, and discount rates did not change the results. Our results suggested that drug treatment was not cost-effective compared with nondrug treatment for stage I hypertensive patients aged ≥65 years without cardiovascular disease in China.
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Affiliation(s)
- Yan-Feng Zhou
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Na Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Pei Wang
- Department of Health Economics, School of Public Health, Fudan University, Shanghai, China
| | - Jae Jeong Yang
- Vanderbilt Epidemiology Center, Vanderbilt University Medical Center, Nashville, USA
| | - Xing-Yue Song
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiong-Fei Pan
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaomin Zhang
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Ministry of Education Key Laboratory of Environment and Health, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Meian He
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Ministry of Education Key Laboratory of Environment and Health, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Honglan Li
- State Key Laboratory of Oncogene and Related Genes & Department of Epidemiology, Shanghai Cancer Institute, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yu-Tang Gao
- State Key Laboratory of Oncogene and Related Genes & Department of Epidemiology, Shanghai Cancer Institute, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yong-Bing Xiang
- State Key Laboratory of Oncogene and Related Genes & Department of Epidemiology, Shanghai Cancer Institute, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Tangchun Wu
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Ministry of Education Key Laboratory of Environment and Health, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Danxia Yu
- Vanderbilt Epidemiology Center, Vanderbilt University Medical Center, Nashville, USA
| | - An Pan
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Ministry of Education Key Laboratory of Environment and Health, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Almalki ZS, Iqbal MS, Alablan FM, Alenazi RK, Tasha AR, Daghar MF, Aldossary NM. Long Term Cost-Effectiveness of a Systolic Blood Pressure Goal of <120 mmHg in Hypertensive Patients Without Diabetes Mellitus. Value Health Reg Issues 2020; 21:157-163. [DOI: 10.1016/j.vhri.2019.09.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 08/21/2019] [Accepted: 09/09/2019] [Indexed: 11/29/2022]
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Ren M, Xuan D, Lu Y, Fu Y, Xuan J. Economic evaluation of olmesartan/amlodipine fixed-dose combination for hypertension treatment in China. J Med Econ 2020; 23:394-400. [PMID: 31782677 DOI: 10.1080/13696998.2019.1699799] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objectives: To evaluate the cost-effectiveness of olmesartan/amlodipine fixed-dose combination vs olmesartan and amlodipine free combination, amlodipine single drug, and valsartan/amlodipine fixed-dose combination in the treatment of hypertensive patients from payer perspective in China.Methods: A Markov model was constructed, which included five health states of hypertensive patients who are aged 35-84 years at baseline and free of cardiovascular disease. Clinical data were obtained from a network meta-analysis. Epidemiology data, adverse events (AEs), cost, and utility data were obtained from the literature. The cost associated with AEs was estimated based on the cost of same symptoms of hypertensive patients in an electric medical record database. The model projected quality-adjusted life years (QALYs) gained, total costs per patient in a 20-year time horizon, and incremental cost-effectiveness ratios. Probability sensitivity analyses (PSA) and one-way sensitivity analyses were conducted for the main parameters to test the robustness of the model.Results: Compared to olmesartan and amlodipine free combination, amlodipine, and valsartan/amlodipine fixed-dose combination, treatment with olmesartan/amlodipine fixed-dose combination led to fewer CVD events and deaths; resulted in an incremental cost of ¥-5,439 ($-791.36), ¥6,530 ($950.09), and ¥-1,019 ($-148.26) and gained additional QALYs of 0.052, 0.094, and 0.037 per patient, respectively. Compared with olmesartan and amlodipine free combination and valsartan/amlodipine fixed-dose combination, olmesartan/amlodipine fixed-dose combination was dominant. Compared with amlodipine alone, the incremental cost-effectiveness ratios were below the WHO recommended cost-effectiveness threshold, indicating the olmesartan/amlodipine fixed-dose combination was a cost-effective option for hypertensive patients in China. The 10-years' time horizon scenario analysis showed similar results to the 20-years' time horizon. Probabilistic sensitivity analysis and one-way sensitivity analyses showed the robustness of the model results.Conclusions: Olmesartan/amlodipine fixed-dose combination confers better health outcomes and costs less compared with olmesartan and amlodipine free combination and valsartan/amlodipine fixed-dose combination, and is cost-effective compared to amlodipine for hypertension treatment in China.
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Affiliation(s)
- Maodong Ren
- Shanghai Centennial Scientific Co., Ltd, Shanghai, China
| | - Dennis Xuan
- Gillings Global School of Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Yongji Lu
- Shanghai Centennial Scientific Co., Ltd, Shanghai, China
| | - YuYan Fu
- Health Economic Research Institute, Sun Yat-Sen University, Guangzhou, China
| | - Jianwei Xuan
- Health Economic Research Institute, Sun Yat-Sen University, Guangzhou, China
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Wang Z, Luo Y, Yang S, Zuo M, Pei R, He J, Deng Y, Zhou M, Zhao L, Guo H, Zou K. Death burden of high systolic blood pressure in Sichuan Southwest China 1990-2030. BMC Public Health 2020; 20:406. [PMID: 32223743 PMCID: PMC7104502 DOI: 10.1186/s12889-020-8377-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 02/20/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Hypertension is highly prevalent and is the primary risk factor for cardiovascular disease (CVD) and chronic kidney disease (CKD). While declining in some developed countries, it is increasing rapidly in some developing countries. Sichuan province is the largest and underdeveloped region in southwest China, with 486 thousand square kilometers, more than 80 million residents, unbalanced economic development, and high prevalence, low awareness, low treatment and low control rate of hypertension. We forecasted the death burden due to high systolic blood pressure (SBP) in Sichuan from 1990 to 2030, to raise the awareness of public and government of the importance and benefits of hypertension control. METHODS We conducted secondary analysis based on data of Global Burden of Disease (GBD) 1990-2015, and predicted the population SBP level, population attributable fraction, and death burden for people aged 30-69 under different scenarios in 2030. RESULTS Comparing with natural trend, if the prevalence of high SBP can be reduced relatively by 25% by 2030, the deaths of non-communicable chronic diseases (NCDs), CVD and CKD would be reduced by 27.1 thousand, 26.2 thousand and 0.8 thousand for people aged 30-69; the mortality would be reduced by 10.8, 32.8 and 16.0%; and the premature mortality would be reduced by 9.9, 32.0 and 16.0%, respectively. CONCLUSIONS Controlling or decreasing the prevalence of high SBP can significantly reduce the deaths, death rate and premature mortality of NCDs, CVD and CKD for the 30-69 years old population in Sichuan. There would be huge benefits for the governments to take cost-effective measures to control or reduce the prevalence of hypertension.
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Affiliation(s)
- Zhuo Wang
- Department of Chronic and Non-communicable Disease Control and Prevention, Sichuan Center of Disease Control and Prevention, Chengdu, China
| | - Yu Luo
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Shujuan Yang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Mingliang Zuo
- Department of Cardiovascular Ultrasound and Non-invasive Cardiology, Sichuan Provincial People's Hospital, Affiliated Hospital of University of Electronic Science and Technology, Chengdu, Sichuan, China
| | - Rong Pei
- School of Health Caring Industry, Sichuan University of Arts and Science, Dazhou, Sichuan, China
| | - Jun He
- Department of Chronic and Non-communicable Disease Control and Prevention, Sichuan Center of Disease Control and Prevention, Chengdu, China
| | - Yin Deng
- Department of Chronic and Non-communicable Disease Control and Prevention, Sichuan Center of Disease Control and Prevention, Chengdu, China
| | - Maigeng Zhou
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Li Zhao
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Hui Guo
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China.
| | - Kun Zou
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China.
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Almalki Z, Alatawi Y, Alharbi A, Almaklefi B, Alfaiz S, Almohana O, Alsaidan Y, Alanezi A. Cost-Effectiveness of More Intensive Blood Pressure Treatment in Patients with High Risk of Cardiovascular Disease in Saudi Arabia: A Modelling Study of Meta-Analysis. Int J Hypertens 2019; 2019:6019401. [PMID: 31662901 PMCID: PMC6791260 DOI: 10.1155/2019/6019401] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 08/07/2019] [Accepted: 09/04/2019] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE The current literature suggests that more intensive blood pressure (BP) treatment is clinically more effective than less intensive treatment in patients at high risk for cardiovascular disease (CVD). In this analysis, we evaluated the potential clinical benefit and cost-effectiveness of more intensive BP treatment in patients at high risk of developing CVD over their lifetimes. METHODS A Markov state-transition model was developed for the BP strategies to estimate the lifetime incremental cost-effectiveness ratio (ICER) per quality-adjusted-life-year (QALY) using evidence published from a meta-analysis. The other model inputs were retrieved from previous studies. Estimated costs were collected from five hospitals in Riyadh. The model used a lifetime framework adopting Saudi payer perspective and applied a 3% annual discount rate. Sensitivity analysis was conducted using one-way and probabilistic sensitivity analysis (PSA) to evaluate the robustness and uncertainty of the estimates. RESULTS Treating 10,000 patients with high CVD risk with more intensive BP therapy would avert a total of 873 CV events over their remaining lifetimes as compared with a less intensive strategy. The projections showed that more intensive BP therapy would be cost-effective compared to the less intensive strategy with incremental costs per QALY of $20,358. Probabilistic sensitivity analysis suggested more intensive control would be cost-effective compared with the less intensive control of BP 87.25 % of the time. CONCLUSION The result of this study showed that more intensive BP treatment appears to be a cost-effective choice for patients with a high risk of CVD in Saudi Arabia when compared with a less intensive BP strategy. Thus, this finding provides strong evidence for the adoption of this strategy within the Saudi healthcare system.
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Affiliation(s)
- Ziyad Almalki
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj, Riyadh, Saudi Arabia
| | - Yasser Alatawi
- Department of Clinical Pharmacy, College of Pharmacy, Umm Al-Qura University, Mecca, Riyadh, Saudi Arabia
| | - Adnan Alharbi
- Department of Clinical Pharmacy, College of Pharmacy, Umm Al-Qura University, Mecca, Riyadh, Saudi Arabia
| | - Bader Almaklefi
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj, Riyadh, Saudi Arabia
| | - Suliman Alfaiz
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj, Riyadh, Saudi Arabia
| | - Omar Almohana
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj, Riyadh, Saudi Arabia
| | - Yasser Alsaidan
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj, Riyadh, Saudi Arabia
| | - Abdullah Alanezi
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj, Riyadh, Saudi Arabia
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