Cost-effectiveness analysis of guidelines for antihypertensive care in Finland

A systematic review of whole disease models for informing healthcare resource allocation decisions

BACKGROUND

Whole disease models (WDM) are large-scale, system-level models which can evaluate multiple decision questions across an entire care pathway. Whilst this type of model can offer several advantages as a platform for undertaking economic analyses, the availability and quality of existing WDMs is unknown.

OBJECTIVES

This systematic review aimed to identify existing WDMs to explore which disease areas they cover, to critically assess the quality of these models and provide recommendations for future research.

METHODS

An electronic search was performed on multiple databases (MEDLINE, EMBASE, the NHS Economic Evaluation Database and the Health Technology Assessment database) on 23rd July 2023. Two independent reviewers selected studies for inclusion. Study quality was assessed using the National Institute for Health and Care Excellence (NICE) appraisal checklist for economic evaluations. Model characteristics were descriptively summarised.

RESULTS

Forty-four WDMs were identified, of which thirty-two were developed after 2010. The main disease areas covered by existing WDMs are heart disease, cancer, acquired immune deficiency syndrome and metabolic disease. The quality of included WDMs is generally low. Common limitations included failure to consider the harms and costs of adverse events (AEs) of interventions, lack of probabilistic sensitivity analysis (PSA) and poor reporting.

CONCLUSIONS

There has been an increase in the number of WDMs since 2010. However, their quality is generally low which means they may require significant modification before they could be re-used, such as modelling AEs of interventions and incorporation of PSA. Sufficient details of the WDMs need to be reported to allow future reuse/adaptation.

Cost-effectiveness of a hypertension control intervention in three community health centers in China

BACKGROUND

Hypertension and associated chronic diseases impose enormous and growing health and economic burdens worldwide. The objective of this study was to investigate the cost-effectiveness (CE) of a hypertension control program in China.

METHODS

We collected information on program costs and health outcomes in three community health centers over a 1-year period. The participants were 4902 people with hypertension (systolic blood pressure [SBP] ≥140 mm Hg and/or diastolic blood pressure [DBP] ≥90 mm Hg, or on hypertension medication) aged 18 years and older. The SBP and DBP changes in the populations were estimated from a random sample of 818 participants by conducting face-to-face interviews and physical examinations. We derived CE measures based on the costs and effects on health outcomes.

FINDINGS

The total cost of implementing the intervention was Renminbi (RMB) 240 772 yuan (US$35 252), or 49 yuan (US$7.17) per participant in 2009. On average, SBP decreased from 143 to 131 mm Hg (P < .001) and DBP decreased from 84 to 78 mm Hg (P < .001), the SBP decreases ranged from 7.6 to 17.8 mm Hg and DBP decreases ranged from 3.9 to 8.3 mm Hg. CE ratios ranged from RMB 3.6 to 5.0 yuan (US$0.53-US$0.73) per person per mm Hg SBP decrease, and from RMB 6.3 to 9.7 yuan (US$0.92-US$1.42) per person per mm Hg DBP decrease.

INTERPRETATION

Per capita costs varied widely across the communities, as did changes in SBP and DBP, but CE was similar. The findings suggest (a) a positive correlation between per capita costs and program effectiveness, (b) differences in intervention levels, and (c) differences in health status. CE results could be helpful to policy makers in making resource allocation decisions.

A cost-utility analysis of hypertension treatment in Greece: assessing the impact of age, sex and smoking status, on outcomes

OBJECTIVES

To assess the cost-utility of hypertension treatment versus a hypothetical 'no-treatment' strategy in Greece.

METHODS

A six-state Markov model simulated the occurrence of major cardiovascular events for hypertensive patients over a 20-year period. Baseline population consisted of a cohort of 1453 patients (46.92% men) that were followed up for a 1-year period, during which health-resource use and clinical characteristics of hypertension were documented. Age, sex and smoking status - specific transition probabilities in the model - were estimated via the HellenicSCORE and Framingham risk equations. The analysis followed a third-party payer perspective.

RESULTS

Incremental cost-effectiveness ratios (ICERs) of treatment versus no treatment were 3539&OV0556;/quality-adjusted life year (QALY), 3986&OV0556;/QALY, 3957&OV0556;/QALY and 5485&OV0556;/QALY gained for men smokers, men nonsmokers, women smokers and women nonsmokers, respectively. ICERs became more favorable with an increase in the years of treatment and advanced age of treatment initiation across all study groups. The probabilistic sensitivity analysis showed that the base-case scenario results were cost-effective for an implicit 30 000&OV0556;/QALY threshold at 97.4, 95.2, 94.8, and 86% of the 10 000 Monte Carlo simulations for men smokers, men nonsmokers, women smokers and women nonsmokers, respectively.

CONCLUSION

In the case of hypertension, one of the most prevalent and modifiable diseases/risk factors, that is accompanied by large-scale costs, the above analysis demonstrates that treatment is a highly cost-effective intervention that should be further supported at the patient and the system level.

Economic evaluation of lifestyle interventions for preventing diabetes and cardiovascular diseases

Lifestyle interventions (i.e., diet and/or physical activity) are effective in delaying or preventing the onset of diabetes and cardiovascular disease. However, policymakers must know the cost-effectiveness of such interventions before implementing them at the large-scale population level. This review discusses various issues (e.g., characteristics, modeling, and long-term effectiveness) in the economic evaluation of lifestyle interventions for the primary and secondary prevention of diabetes and cardiovascular disease. The diverse nature of lifestyle interventions, i.e., type of intervention, means of provision, target groups, setting, and methodology, are the main obstacles to comparing evaluation results. However, most lifestyle interventions are among the intervention options usually regarded as cost-effective. Diabetes prevention programs, such as interventions starting with targeted or universal screening, childhood obesity prevention, and community-based interventions, have reported favorable cost-effectiveness ratios.