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Chay J, Jafar TH, Su RJ, Shirore RM, Tan NC, Finkelstein EA. Cost-Effectiveness of a Multicomponent Primary Care Intervention for Hypertension. J Am Heart Assoc 2024; 13:e033631. [PMID: 38606776 DOI: 10.1161/jaha.123.033631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 03/11/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND The SingHypertension primary care clinic intervention, which consisted of clinician training in hypertension management, subsidized single-pill combination medications, nurse-delivered motivational conversations and telephone follow-ups, improved blood pressure control and cardiovascular disease (CVD) risk scores relative to usual care among patients with uncontrolled hypertension in Singapore. This study quantified the incremental cost-effectiveness, in terms of incremental cost per unit reduction disability-adjusted life years, of SingHypertension relative to usual care for patients with hypertension from the health system perspective. METHODS AND RESULTS We developed a Markov model to simulate CVD events and associated outcomes for a hypothetical cohort of patients over a 10-year period. Costs were measured in US dollars, and effectiveness was measured in disability-adjusted life years averted. We present base-case results and conducted deterministic and probabilistic sensitivity analyses. Based on a willingness-to-pay threshold of US $55 500 per DALY averted, SingHypertension was cost-effective for patients with hypertension (incremental cost-effectiveness ratio: US $24 765 per disability-adjusted life year averted) relative to usual care. This result held even if risk reduction was assumed to decline linearly to 0 over 10 years but not sooner than 7 years. Incremental cost-effectiveness ratios were most sensitive to the magnitude of the reduction in CVD risk; at least a 0.13% to 0.16% point reduction in 10-year CVD risk is required for cost-effectiveness. Probabilistic sensitivity analysis indicates that SingHypertension has a 78% chance of being cost-effective at the willingness-to-pay threshold. CONCLUSIONS SingHypertension represents good value for the money for reducing CVD incidence, morbidity, and mortality and should be considered for wide-scale implementation in Singapore and possibly other countries. REGISTRATION INFORMATION REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02972619.
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Affiliation(s)
- Junxing Chay
- Program in Health Services & Systems Research Duke-NUS Medical School Singapore
| | - Tazeen H Jafar
- Program in Health Services & Systems Research Duke-NUS Medical School Singapore
- Department of Renal Medicine Singapore General Hospital Singapore
- Duke Global Health Institute Durham NC USA
| | - Rebecca J Su
- Program in Health Services & Systems Research Duke-NUS Medical School Singapore
| | - Rupesh M Shirore
- Program in Health Services & Systems Research Duke-NUS Medical School Singapore
| | | | - Eric A Finkelstein
- Program in Health Services & Systems Research Duke-NUS Medical School Singapore
- Duke Global Health Institute Durham NC USA
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2
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Li J, Zhao D, Cai J, Chen S, Wu S, Qi Y. Cost-effectiveness of treatment in adults with blood pressure of 130-139/80-89 mmHg and high cardiovascular risk in China: a modelling study. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2024; 42:100962. [PMID: 38045985 PMCID: PMC10689267 DOI: 10.1016/j.lanwpc.2023.100962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 10/17/2023] [Accepted: 10/24/2023] [Indexed: 12/05/2023]
Abstract
Background The most recent updated hypertension guidelines recommend individuals with systolic blood pressure (SBP)/diastolic blood pressure (DBP) of 130-139/80-89 mmHg and high cardiovascular risk should receive antihypertensive drug treatment. This study aimed to assess the benefits and cost-effectiveness of medication for people aged ≥35 years with this blood pressure stratum and high cardiovascular risk in China. Methods The benefits of drug treatment in adults aged ≥35 years with SBP/DBP of 130-139/80-89 mmHg and high cardiovascular risk were evaluated in decision-analytic simulation models. Decreasing numbers of cardiovascular disease (CVD) events and premature deaths from all causes and increasing quality-adjusted life-years (QALYs) from drug treatment were estimated in 10-year and lifetime horizons. The incremental cost-effectiveness ratios (ICER) for drug treatment were calculated. Findings Among approximately 106.60 million Chinese adults aged ≥35 years with this blood pressure stratum and high cardiovascular risk, drug treatment was estimated to prevent 2,060,000 strokes and 660,000 myocardial infarctions over a 10-year time horizon. Adults prescribed antihypertensive drugs could gain 0.034 incremental QALYs. Over a lifetime horizon, adults who start treatment earlier could benefit more in preventing CVD and gaining incremental QALYs. The medication treatment is cost-effective either over a 10-year time horizon with an ICER of Int$13321.29 per QALY gained or over the remaining lifetime. Interpretation Antihypertensive treatment of adults with SBP/DBP of 130-139/80-89 mmHg and high cardiovascular risk would gain substantial benefits with cost-effectiveness. The young and middle-aged population would derive the most benefit. Funding National Natural Science Foundation of China, and Beijing Natural Science Foundation.
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Affiliation(s)
- Jiangtao Li
- Center for Clinical and Epidemiologic Research, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, The Key Laboratory of Remodelling-Related Cardiovascular Diseases, Ministry of Education, Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing 100029, China
| | - Dong Zhao
- Center for Clinical and Epidemiologic Research, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, The Key Laboratory of Remodelling-Related Cardiovascular Diseases, Ministry of Education, Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing 100029, China
| | - Jun Cai
- Hypertension Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease of China, National Center for Cardiovascular Diseases of China, Chinese Academy of Medical Sciences and Peking Union Medical College, Beilishi Rd. 167, Xicheng District, Beijing 100037, China
| | - Shuohua Chen
- Department of Cardiology, Kailuan Hospital, 57 Xinhua East Rd, Tangshan 063000, China
| | - Shouling Wu
- Department of Cardiology, Kailuan Hospital, 57 Xinhua East Rd, Tangshan 063000, China
| | - Yue Qi
- Center for Clinical and Epidemiologic Research, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, The Key Laboratory of Remodelling-Related Cardiovascular Diseases, Ministry of Education, Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing 100029, China
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Feng A, Lin W, Li L, Zeng M, Lyu J. Pharmacoeconomic evaluation of stroke and myocardial infarction prevention in hypertensive patients: Markov model based on the ACCOMPLISH trial. J Int Med Res 2023; 51:3000605231214921. [PMID: 38114070 PMCID: PMC10731996 DOI: 10.1177/03000605231214921] [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: 04/01/2023] [Accepted: 10/30/2023] [Indexed: 12/21/2023] Open
Abstract
OBJECTIVE We evaluated the pharmacoeconomics of amlodipine combined with benazepril and hydrochlorothiazide combined with benazepril in the treatment of hypertension using a Markov model to provide an evidence-based reference for clinical drug use. METHODS In this retrospective study, we constructed two types of Markov model using data from the ACCOMPLISH (Avoiding Cardiovascular Events through Combination Therapy in Patients Living with Systolic Hypertension) trial to dynamically simulate the development of hypertension. The models were subjected to rollback analysis and cohort analysis to obtain the cost and effectiveness of the two drug regimens in preventing stroke and myocardial infarction in hypertensive patients. We conducted sensitivity analysis to determine the stability of the results. RESULTS The cost-effectiveness of amlodipine combined with benazepril was 66,196.97 RMB with 6.59 QALYs and that of hydrochlorothiazide combined with benazepril was 74,588.50 RMB with 6.46 QALYs. The incremental cost-effectiveness ratio of hydrochlorothiazide + benazepril was -64,550.23 compared with amlodipine + benazepril. The amlodipine + benazepril regimen was therefore more cost-effective than hydrochlorothiazide combined with benazepril. The sensitivity analysis results showed that the model was robust. CONCLUSION Compared with the hydrochlorothiazide + benazepril treatment regimen, the amlodipine + benazepril regimen showed greater economic benefits.
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Affiliation(s)
- Aozi Feng
- Department of Clinical Research, First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China
| | - Weizhao Lin
- The First Clinical Medical College of Jinan University, Guangzhou, Guangdong, China
| | - Li Li
- Department of Clinical Research, First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China
| | - Mengnan Zeng
- College of Pharmacy, Henan University of Chinese Medicine, Zhengzhou, Henan, China
| | - Jun Lyu
- Department of Clinical Research, First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of Traditional Chinese Medicine Informatization, Guangzhou, Guangdong, China
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Zhang H, Ding Y, Qin S. Preference between Chinese and Western medicines for hypertension treatment: Evidences based on Chinese population aged ≥ 45 years. Medicine (Baltimore) 2023; 102:e36158. [PMID: 37986303 PMCID: PMC10659625 DOI: 10.1097/md.0000000000036158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 10/25/2023] [Accepted: 10/26/2023] [Indexed: 11/22/2023] Open
Abstract
Hypertension is one of the chronic diseases that threaten the health of the elderly population. This study aims to explore the treatment and medication preferences in Chinese elderly patients (≥45 years old) with hypertension, and to investigate the relevant influencing factors. A cross-sectional design was adopted. Utilizing the data from the public database CHARLS 2018, the factors influencing the treatment and medication preference among the elderly hypertensive patients were explored with multinomial logistic regression models. A total of 6588 hypertensive patients aged ≥ 45 years were included in this study, of which 5135 (77.94%) received treatment. Besides, 4939 (96.18%) chose oral medication, which was the most preferred treatment for these patients. The proportion of patients who chose "oral medication only" increased with age, but decreased with educational level and self-reported health. Patients with higher educational levels were more likely to choose other modalities of treatment. In particular, patients with better self-reported health were more willing to try traditional Chinese medication (TCM). Lower income group without medical insurance preferred to choose "Chinese medicine only." Patients aged ≥ 75 years, urban residents, and those with 2 or more chronic diseases were more willing to try combined Chinese and Western medicines. Patients' preference for TCM therapy was correlated positively with the provincial economic welfare factor, and negatively with the provincial medical and social welfare factors. During treatment of patients with hypertension, clinicians should pay attention to their preferences and formulate personalized regimens for them, in order to improve their compliance with treatment. Additionally, the government should steadily improve the local medical benefits, thereby facilitating the promotion and application of local TCM services.
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Affiliation(s)
- Hangjing Zhang
- School of Public Health, Hangzhou Normal University, Hangzhou, China
| | - Ye Ding
- School of Public Health, Hangzhou Medical College, Hangzhou, China
| | - Shangren Qin
- School of Public Health, Hangzhou Normal University, Hangzhou, China
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Zhao X, Chen Y, Yang G, Li X, Tang X, Yang Q, Peng L, Li J, Liang Z, Li A, Wang W, Huang M, Liu T, Li X, Jiang W. Initial treatment with a single capsule containing half-dose quadruple therapy vs standard-dose dual therapy in hypertensive patients (QUADUAL): Study protocol for a randomized, blinded, crossover trial. Am Heart J 2023; 264:10-19. [PMID: 37276913 DOI: 10.1016/j.ahj.2023.05.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 05/14/2023] [Accepted: 05/28/2023] [Indexed: 06/07/2023]
Abstract
BACKGROUND Combined antihypertensive therapy has obvious advantages over single drug therapy. Hypertension guidelines fully affirm the efficacy of dual combination in initial antihypertensive therapy. Recent studies have also pointed out that the quadruple combination of very low-dose antihypertensive drugs is superior to single drugs. However, whether low-dose quadruple therapy is better than dual combination is unknown. OBJECTIVE To evaluate and compare the efficacy and safety of half-dose quadruple therapy vs standard-dose dual therapy in the initial treatment of hypertensive patients with systolic/diastolic blood pressure 140-179/90-109 mm Hg. METHODS A randomized double-blind crossover clinical trial will be conducted to compare the efficacy and safety of low-dose quadruple antihypertensives (irbesartan 75 mg + metoprolol 23.75 mg + amlodipine 2.5 mg + indapamide 1.25 mg) with standard-dose dual antihypertensives (irbesartan 150 mg + amlodipine 5 mg) in the initial treatment of patients with mild to moderate hypertension (140-179/90-109 mm Hg). Ninety patients are required and will be recruited and randomly assigned in a 1:1 ratio to 2 crossover groups. Two groups will receive a different combination therapy for 4 weeks, then switch to the other combination therapy for 4 weeks, with a 2-week wash-out. The patients will be followed up for 4 weeks to compare the antihypertensive effects and related adverse effects of the 2 antihypertensive combination treatments. CONCLUSIONS We present the rationale for the design of the QUADUAL trial. The trial started in July 2022 and is expected to be completed by August 2023. The study aims to evaluate if an initial treatment regimen of quadruple combination of half-dose blood pressure medications will result in greater reduction in blood pressure and fewer side effects compared to standard dose dual therapy. REGISTRATION www. CLINICALTRIALS gov (NCT05377203).
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Affiliation(s)
- Xiexiong Zhao
- Department of Cardiology, The Third Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Ye Chen
- Department of Cardiology, The Third Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Guoping Yang
- Center of Clinical Pharmacology, The Third Xiangya Hospital of Central South University, Changsha, Hunan, China; Department of Clinical Pharmacology, Xiangya School of Pharmaceutical Sciences, Changsha, Hunan, China
| | - Xingli Li
- Department of Epidemiology, Xiangya School of Public Health, Changsha, Hunan, China
| | - Xiaohong Tang
- Department of Cardiology, The Third Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Qiong Yang
- Department of Cardiology, The Third Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Liping Peng
- Department of Cardiology, The Third Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Jingle Li
- Department of Cardiology, The Third Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Zhongshu Liang
- Department of Cardiology, The Third Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Anying Li
- Department of Cardiology, The Third Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Wenjuan Wang
- Department of Cardiology, The Third Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Miao Huang
- Department of Cardiology, The Third Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Tao Liu
- Department of Cardiology, The Third Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Xiaogang Li
- Department of Cardiology, The Third Xiangya Hospital of Central South University, Changsha, Hunan, China.
| | - Weihong Jiang
- Department of Cardiology, The Third Xiangya Hospital of Central South University, Changsha, Hunan, China; Hypertension Research Center of Hunan Province, Changsha, Hunan, China.
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Li YY, Liu JP, Shi SF, Yang KZ, Gong Y, Sun J, Xie Q, Wu XL, Liu QG, Xu M. Acupuncture with twirling reinforcing and reducing manipulation shows a control of hypertension and regulation of blood pressure-related target brain regions in spontaneously hypertensive rat: a preliminary resting-state functional MRI study. Front Neurosci 2023; 17:1161578. [PMID: 37304030 PMCID: PMC10250630 DOI: 10.3389/fnins.2023.1161578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 05/10/2023] [Indexed: 06/13/2023] Open
Abstract
Aim To observe the effects of acupuncture manipulations on blood pressure and brain function in spontaneously hypertensive rats and elucidate the anti-hypertensive effect of the manipulations' central mechanism. Methods This study used acupuncture twirling reinforcing, acupuncture twirling reducing, and acupuncture twirling uniform reinforcing-reducing manipulations to act on the bilateral TaiChong point of rats. The depth of acupuncture was 1.5-2 mm, and twisting was performed at a frequency of 60 times/min within ±360° for 3 min, followed by the needle being retained for 17 min. Functional magnetic resonance imaging was performed at the end of the intervention. Regional homogeneity and amplitude of low-frequency fluctuations were used to assess the differences in brain regions in each group of rats, and the core brain region (left hypothalamus) among the differential brain regions was selected as the seed for functional connectivity analysis. Results (1) The anti-hypertensive effect was achieved by acupuncture manipulations, and the anti-hypertensive effect of twirling reducing manipulation on spontaneously hypertensive rats was better than that of twirling uniform reinforcing-reducing and twirling reinforcing manipulations. (2) After regional homogeneity and amplitude of low-frequency fluctuations analyses, the hypothalamus, the brain region related to blood pressure, was activated in the twirling uniform reinforcing-reducing manipulation group; the corpus callosum and cerebellum were activated in the twirling reinforcing manipulation group; and the hypothalamus, olfactory bulb, corpus callosum, brainstem, globus pallidum, and striatum were activated in the twirling reducing manipulation group. (3) According to the functional connectivity analysis, different acupuncture manipulations increased the functional connections between seed points and the brainstem, olfactory bulb, and cerebellum, etc. Conclusion These results suggest that acupuncture manipulations achieved the hypotensive effect and the twirling reducing manipulation had a better hypotensive effect on spontaneously hypertensive rats than twirling uniform reinforcing-reducing and twirling reinforcing manipulations; the central mechanism of the anti-hypertensive effect of twirling reinforcing and reducing manipulation may be related to the activation of brain regions associated with blood pressure regulation and the functional connections between them. Furthermore, brain regions involved in motor control, cognition, and hearing were also activated. We hypothesize that activation of these brain regions may help prevent or mitigate the onset and progression of hypertensive brain damage.
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Affiliation(s)
- Yin-Yin Li
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Ji-Peng Liu
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Shu-Feng Shi
- Department of Tuina, Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing, China
| | - Ke-Zhen Yang
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Yu Gong
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Jiao Sun
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Qi Xie
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Xiao-Li Wu
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Qing-Guo Liu
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Meng Xu
- Department of Tuina, Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing, China
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Zhao SQ, Zhao LP, Xu XP, You H. Individual-Level Health Care Costs Attributable to Noncommunicable Diseases: A Longitudinal Study Based on the Older Adults in China. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2023; 60:469580231214469. [PMID: 38044620 PMCID: PMC10697053 DOI: 10.1177/00469580231214469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 10/11/2023] [Accepted: 10/27/2023] [Indexed: 12/05/2023]
Abstract
Noncommunicable chronic diseases among the elderly population represent a significant economic burden in China. However, previous disease-related health cost studies lacked representation of older adults and comparability of the burden of multiple chronic diseases. The objective of this study was to determine the fraction of health care costs attributable to the 6 most prevalent chronic diseases and comorbidities in the sample of older adults. This study employed data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS), with 3 waves in 2011, 2014, and 2018, and included 18 349 observations in total. Outpatient costs, inpatient costs, and total health care costs were included in this study. Based on a 2-part random effects model, the effect of chronic disease on health service utilization was first explored by constructing a dummy variable for whether or not to utilize health care, followed by estimation of attributable costs in the population with health care utilization. Among the older adults in the sample, hypertension, heart disease, cataracts, arthritis, stroke or Cerebrovascular disease (CVD) and chronic lung disease are the 6 most prevalent chronic conditions. The costs attributable to the 6 chronic diseases mentioned above were 36.00% of outpatient costs, 55.92% of inpatient costs, and 45.05% of total health care costs for older adults. Of these, heart disease, stroke or CVD, and chronic lung disease accounted for 22.11%, 13.24%, and 10.56% of total health care costs, respectively. Moreover, the proportion of health care costs attributable to chronic diseases was higher for older adults who were male, lived in urban areas, and had a lower level of education. The proportion of health care costs attributable to chronic diseases is substantial among older adults in China. Health care costs associated with chronic diseases can be decreased with well-targeted interventions and comprehensive access to health services.
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Affiliation(s)
| | | | | | - Hua You
- Nanjing Medical University, Nanjing, China
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Zhou Q, Yu M, Jin M, Zhang P, Qin G, Yao Y. Impact of free hypertension pharmacy program and social distancing policy on stroke: A longitudinal study. Front Public Health 2023; 11:1142299. [PMID: 37143973 PMCID: PMC10151749 DOI: 10.3389/fpubh.2023.1142299] [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: 02/03/2023] [Accepted: 03/28/2023] [Indexed: 05/06/2023] Open
Abstract
Background The estimated lifetime risk of stroke was the highest in East Asia worldwide, especially in China. Antihypertensive therapy can significantly reduce stroke mortality. However, blood pressure control is poor. Medication adherence is a barrier as patients' out-of-pocket costs have risen. We aimed to take advantage of a free hypertension pharmacy intervention and quantified the impact on stroke mortality. Methods A free pharmaceutical intervention program was implemented in Deqing, Zhejiang province in April 2018. Another non-pharmaceutical intervention, social distancing due to the pandemic of Coronavirus disease 2019 (COVID-19), was also key to affecting stroke mortality. We retrospectively collected the routine surveillance data of stroke deaths from Huzhou Municipal Center for Disease Prevention and Control in 2013-2020 and obtained within-city mobility data from Baidu Migration in 2019-2020, then we quantified the effects of both pharmaceutical intervention and social distancing using Serfling regression model. Results Compared to the predicted number, the actual number of stroke deaths was significantly lower by 10% (95% CI, 6-15%; p < 0.001) from April 2018 to December 2020 in Deqing. Specifically, there was a reduction of 19% (95% CI, 10-28%; p < 0.001) in 2018. Moreover, we observed a 5% (95% CI, -4 - 14%; p = 0.28) increase in stroke mortality due to the adverse effect of COVID-19 but it wasn't statistically significant. Conclusion Free hypertension pharmacy program has great potential to prevent considerable stroke deaths. In the future, the free supply of low-cost, essential medications that target patients with hypertension at increased risk of stroke could be taken into account in formulating public health policies and guiding allocations of health care resources.
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Affiliation(s)
- Qi Zhou
- Department of Biostatistics, School of Public Health and The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - Meihua Yu
- Huzhou Center for Disease Control and Prevention, Huzhou, Zhejiang, China
| | - Meihua Jin
- Huzhou Center for Disease Control and Prevention, Huzhou, Zhejiang, China
- *Correspondence: Meihua Jin,
| | - Peng Zhang
- Huzhou Center for Disease Control and Prevention, Huzhou, Zhejiang, China
| | - Guoyou Qin
- Department of Biostatistics, School of Public Health and The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - Ye Yao
- Department of Biostatistics, School of Public Health and The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
- Ye Yao,
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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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10
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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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Lou Y, Yu Y, Liu J, Huang J. Sacubitril-valsartan for the treatment of hypertension in China: A cost-utility analysis based on meta-analysis of randomized controlled trials. Front Public Health 2022; 10:959139. [PMID: 36062091 PMCID: PMC9432800 DOI: 10.3389/fpubh.2022.959139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 07/25/2022] [Indexed: 01/24/2023] Open
Abstract
Background Sacubitril-valsartan was recommended for heart failure (HF) and proven cost-effective in HF. Recently, sacubitril-valsartan has been recommended to treat hypertension by the Chinese expert consensus. The cost utility of sacubitril-valsartan for hypertension remains uninvestigated. Methods A meta-analysis of randomized controlled trials (RCTs) was performed to investigate the real efficacy of sacubitril-valsartan on blood pressure, compared with angiotensin receptor blockers or placebo. A lifetime Markov model was developed to compare the cost utility of sacubitril-valsartan vs. valsartan. The primary outcome was the incremental cost-utility ratio (ICUR), representing the ratio of incremental costs to the incremental utility. The willingness-to-pay (WTP) threshold was three times of per capita gross domestic product (GDP) in China in 2021. Sacubitril-valsartan was considered cost-effective if the ICUR obtained was lower than the WTP threshold, otherwise, sacubitril-valsartanis was not cost-effective. Results A total of 10 RCTs of 5,781 patients were included in the meta-analysis. For comparison of sacubitril-valsartan 400 mg/day vs. valsartan 320 mg/day, a reduction in blood pressure (BP) of -5.97 (-6.38, -5.56) (p < 0.01) was observed. Cost-utility analysis showed that for a 60-year-old patient with hypertension, if sacubitril-valsartan was prescribed as the antihypertensive agent, he had a life expectancy of 11.91 quality-adjusted life-years (QALYs) with costs of 65,066 CNY, and if valsartan was prescribed as the antihypertensive agent, the life expectancy would be 11.82 QALY with costs of 54,769 CNY; thus, an ICUR of 108,622 CNY/QALY was obtained, lower than the WTP threshold. Conclusion Compared with valsartan, sacubitril-valsartan is more effective in reducing blood pressure and may result in more quality-adjusted life-year, although with higher costs. Sacubitril-valsartan is cost-effective for hypertension in the current China setting under the willingness-to-pay threshold of 3 times of per capita GDP.
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Affiliation(s)
- Yake Lou
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ying Yu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jinxing Liu
- Department of Cardiology, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jing Huang
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Fan L, Cai J. Integrated hypertension management and national hypertension discipline promotion in China. Chin Med J (Engl) 2022; 135:00029330-990000000-00071. [PMID: 35861305 PMCID: PMC9532026 DOI: 10.1097/cm9.0000000000002020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Indexed: 11/26/2022] Open
Affiliation(s)
- Luyun Fan
- State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Jun Cai
- State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
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Ma Y, Cao J, Mubarik S, Bai J, Yang D, Zhao Y, Hu Q, Yu C. Age–Period–Cohort Analysis of Long Trend of Mortality for Stroke and Subtypes Attributed to High SBP in Chinese Adults. Front Neurol 2022; 13:710744. [PMID: 35356448 PMCID: PMC8959307 DOI: 10.3389/fneur.2022.710744] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 01/31/2022] [Indexed: 12/29/2022] Open
Abstract
Stroke has been found as the leading cause of death in China, and high systolic blood pressure (SBP) has been indicated as a critical risk factor of stroke mortality. Accordingly, in this article, the aims were to investigate the long-term trends of mortality in terms of stroke and subtypes arising from high SBP stratified by age and gender among Chinese adults. The data of this article originated from the global burden of disease (GBD) study database. The age, period, and cohort effects were examined with the age–period–cohort model (APC). The age-standardized mortality of stroke attributed to high SBP in China has been significantly declining from 1990 to 2019. As indicated by the result of APC analysis, substantially rising age effects have been exerted on stroke and subtypes from 25 to 84 years of both genders, whereas the age effect on women increased less rapidly than that on men. As opposed to the above result, the period and cohort effects were reported to show similar monotonous decrease trends, and stroke of women more significantly declined than that of men (significantly with p < 0.05 for all). All types of stroke mortality arising from high SBP were indicated to change. The risk of death was identified to be most remarkably reduced in high SBP-attributable subarachnoid hemorrhage (SAH), whereas intracerebral hemorrhage (ICH) and ischemic stroke (IS) decreased at approximately the same rate. People born in the later birth cohorts or living in recent periods had a lower risk of stroke death, whereas men and elder groups were considered as the high-risk populations for stroke mortality due to high SBP. Although the stroke mortality relating to high SBP in China was declining, ICH and IS would continue to be the first and second lethal subtypes of stroke. In contrast to the above finding, SAH accounted for the minimum proportion of deaths and the maximum reduction in period and cohort effects. Thus, it is of high significance to introduce advanced hypertension control technology and knowledge regarding healthy lifestyles.
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Affiliation(s)
- Yudiyang Ma
- Department of Epidemiology and Biostatistics, School of Public Health, Wuhan University, Wuhan, China
| | - Jinhong Cao
- Department of Epidemiology and Biostatistics, School of Public Health, Wuhan University, Wuhan, China
| | - Sumaira Mubarik
- Department of Epidemiology and Biostatistics, School of Public Health, Wuhan University, Wuhan, China
| | - Jianjun Bai
- Department of Epidemiology and Biostatistics, School of Public Health, Wuhan University, Wuhan, China
| | - Donghui Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Wuhan University, Wuhan, China
| | - Yudi Zhao
- Department of Epidemiology and Biostatistics, School of Public Health, Wuhan University, Wuhan, China
| | - Qian Hu
- Department of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chuanhua Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Wuhan University, Wuhan, China
- *Correspondence: Chuanhua Yu ; orcid.org/0000-0002-5467-2481
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14
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Cheng J, Zhang Y, Zhong A, Tian M, Zou G, Chen X, Yu H, Song F, Zhou S. Quality of Health Economic Evaluations in Mainland China: A Comparison of Peer-Reviewed Articles in Chinese and in English. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2022; 20:35-54. [PMID: 34322862 DOI: 10.1007/s40258-021-00674-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/07/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Our objective was to assess the incidence and quality of reporting of published health economic evaluations in mainland China and compare the quality of peer-reviewed articles in Chinese and English. METHODS A comprehensive search was conducted for economic evaluations pertaining to China published from 2006 to 2015 using the PubMed, CBM, CMCC, CNKI, VIP, and Wanfang databases. All studies in English that met the inclusion criteria were included. For studies in Chinese, 200 sampled studies were included according to the random seeds method, and the same number of the most-cited studies in Chinese as those in English were included according to the number of citations and journal grades. Researchers independently assessed the quality of the studies using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. RESULTS After literature search and screening, a total of 310 studies were identified. The majority of these studies were cost-effectiveness studies (82.26%). Scores among different CHEERS items varied greatly. There was a gap between the average quality scores of the studies published in Chinese and those published in English (49.78 ± 9.31 vs. 82.48 ± 17.69) and between the average quality scores of the included most-cited studies in Chinese and English, which was slightly smaller (54.08 ± 10.27 vs. 82.48 ± 17.69). The methods, results, and discussion sections of studies published in Chinese were of low quality. CONCLUSION The quality of reporting of health economic evaluations in mainland China has developed slowly. Most of the included studies were incomplete in the presentation of content, making the results less reliable. It is important to standardize and improve the quality of Chinese health economic research.
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Affiliation(s)
- Jiehua Cheng
- School of Public Health and Management, Higher Education Mega Centre, Guangzhou University of Chinese Medicine, No. 232 Wai Huan Dong Road, Panyu District, Guangzhou, 510006, Guangdong, China
| | - Yu Zhang
- School of Public Health and Management, Higher Education Mega Centre, Guangzhou University of Chinese Medicine, No. 232 Wai Huan Dong Road, Panyu District, Guangzhou, 510006, Guangdong, China
| | - Ailin Zhong
- School of Public Health and Management, Higher Education Mega Centre, Guangzhou University of Chinese Medicine, No. 232 Wai Huan Dong Road, Panyu District, Guangzhou, 510006, Guangdong, China
| | - Miao Tian
- Dongfeng Stomatological Hospital, Hubei University of Medicine, Shiyan, Hubei, China
| | - Guanyang Zou
- School of Public Health and Management, Higher Education Mega Centre, Guangzhou University of Chinese Medicine, No. 232 Wai Huan Dong Road, Panyu District, Guangzhou, 510006, Guangdong, China
| | - Xiaping Chen
- Shiyan Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, China
| | - Hongxing Yu
- Shiyan Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, China
| | - Fujian Song
- Faculty of Medicine and Health Science, University of East Anglia, Norwich, UK
| | - Shangcheng Zhou
- School of Public Health and Management, Higher Education Mega Centre, Guangzhou University of Chinese Medicine, No. 232 Wai Huan Dong Road, Panyu District, Guangzhou, 510006, Guangdong, China.
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Araujo MYC, Sarti FM, Turi-Lynch BC, Queiroz DC, Neves VJS, Silvestrini MM, Codogno JS. Cost-utility analysis of traditional drug therapy with and without exercise program for hypertensive patients in real-life data primary health care. MOTRIZ: REVISTA DE EDUCACAO FISICA 2022. [DOI: 10.1590/s1980-657420220006522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
| | | | | | - Dayane Cristina Queiroz
- Universidade Estadual Paulista “Julio de Mesquita Filho”, Brazil; Universidade Estadual Paulista “Julio de Mesquita Filho”, Brazil
| | | | | | - Jamile Sanches Codogno
- Universidade Estadual Paulista “Julio de Mesquita Filho”, Brazil; Universidade Estadual Paulista “Julio de Mesquita Filho”, Brazil
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Xie X, Fan Z, Li Y, Kang J, Zhang D. Combining econometric analysis and simulation modeling to evaluate Population-Based health policies for chronic disease prevention and control. Prev Med Rep 2021; 24:101586. [PMID: 34976646 PMCID: PMC8683848 DOI: 10.1016/j.pmedr.2021.101586] [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: 10/07/2020] [Revised: 08/28/2021] [Accepted: 10/03/2021] [Indexed: 11/28/2022] Open
Abstract
Objectives Population-based health policies play an important role in preventing and controlling chronic disease. Policymakers need to understand both the short- and long-term impacts of different policies to optimize resource allocation. The objective of this study is to develop a framework that combines econometric analysis and simulation modeling for a comprehensive evaluation of population-based health policies. Study design Both econometric analysis and simulation modeling were used to evaluate the impact of a population-based health policy. Methods We identified a cohort of hypertensive patients from the 2011–2013 China Health and Retirement Longitudinal Study and fitted the data into our framework to evaluate the effectiveness of a community-based hypertension-screening program under the Essential Public Health Services (EPHS) policy on the future burden of cardiovascular disease in China. Results Using an econometric approach, we identified that the community-based hypertension screening program would lead to a 7.9% improvement in the rate of hypertension control. Using a validated simulation model, we further estimated that if the policy was fully implemented nationwide, it could avert 97,100 cases of myocardial infarction and 215,600 cases of stroke. The policy would cost $2131 on average to save 1 quality-adjusted life year over 10 years. Conclusions This study proposed a framework integrating two different methods and assessing both short- and long-term impact of a population-based health policy. Through a case study, we demonstrated that combining econometric analysis and simulation modeling could provide policymakers with a more powerful tool to evaluate health policies for controlling chronic disease.
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Affiliation(s)
- Xiaolei Xie
- Center for Healthcare Service Research, Department of Industrial Engineering, Tsinghua University, Beijing, China
| | - Zhenghao Fan
- Center for Healthcare Service Research, Department of Industrial Engineering, Tsinghua University, Beijing, China
| | - Yan Li
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jian Kang
- Harvard T.H. Chan School of Public Health, Boston, USA
| | - Donglan Zhang
- Department of Health Policy and Management, University of Georgia, Athens, USA
- Corresponding author.
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Cao Y, Xie L, Liu K, Liang Y, Dai X, Wang X, Lu J, Zhang X, Li X. The antihypertensive potential of flavonoids from Chinese Herbal Medicine: A review. Pharmacol Res 2021; 174:105919. [PMID: 34601080 DOI: 10.1016/j.phrs.2021.105919] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 09/26/2021] [Accepted: 09/28/2021] [Indexed: 12/11/2022]
Abstract
With the coming of the era of the aging population, hypertension has become a global health burden to be dealt with. Although there are multiple drugs and procedures to control the symptoms of hypertension, the management of it is still a long-term process, and the side effects of conventional drugs pose a burden on patients. Flavonoids, common compounds found in fruits and vegetables as secondary metabolites, are active components in Chinese Herbal Medicine. The flavonoids are proved to have cardiovascular benefits based on a plethora of animal experiments over the last decade. Thus, the flavonoids or flavonoid-rich plant extracts endowed with anti-hypertension activities and probable mechanisms were reviewed. It has been found that flavonoids may affect blood pressure in various ways. Moreover, despite the substantial evidence of the potential for flavonoids in the control of hypertension, it is not sufficient to support the clinical application of flavonoids as an adjuvant or core drug. So the synergistic effects of flavonoids with other drugs, pharmacokinetic studies, clinical trials and the safety of flavonoids are also incorporated in the discussion. It is believed that more breakthrough studies are needed. Overall, this review may shed some new light on the explicit recognition of the mechanisms of anti-hypertension actions of flavonoids, pointing out the limitations of relevant research at the current stage and the aspects that should be strengthened in future researches.
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Affiliation(s)
- Yi Cao
- School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, PR China
| | - Long Xie
- School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, PR China
| | - Kai Liu
- School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, PR China
| | - Youdan Liang
- School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, PR China
| | - Xiaolin Dai
- School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, PR China
| | - Xian Wang
- School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, PR China
| | - Jing Lu
- School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, PR China
| | - Xumin Zhang
- School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, PR China
| | - Xiaofang Li
- School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, PR China.
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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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Bhattarai S, Tandstad B, Shrestha A, Karmacharya B, Sen A. Socioeconomic Status and Its Relation to Hypertension in Rural Nepal. Int J Hypertens 2021; 2021:5542438. [PMID: 34497724 PMCID: PMC8419497 DOI: 10.1155/2021/5542438] [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: 02/05/2021] [Revised: 06/16/2021] [Accepted: 08/18/2021] [Indexed: 01/13/2023] Open
Abstract
INTRODUCTION Hypertension and its association with socioeconomic positions are well established. However, the gradient of these relationships and the mediating role of lifestyle factors among rural population in low- and middle-income countries such as Nepal are not fully understood. We sought to assess the association between socioeconomic factors (education, income, and employment status) and hypertension. Also, we assessed whether the effect of education and income level on hypertension was mediated by lifestyle factors. METHODS This cross-sectional study was conducted among 260 participants aged ≥18 years attending a rural health center in Dolakha, Nepal. Self-reported data on demographic, socioeconomic, and lifestyle factors were collected, and blood pressure, weight, and height were measured for all study participants. Those with systolic blood pressure ≥140 mm Hg or diastolic blood pressure ≥90 mm Hg or administrating high blood pressure-lowering medicines were regarded as hypertensives. Poisson regression models were used to estimate the prevalence ratios and corresponding 95% confidence intervals to assess the association between socioeconomic factors and hypertension. We explored mediation, using the medeff command in Stata for causal mediation analysis of nonlinear models. RESULTS Of the 50 hypertensive participants, sixty percent were aware of their status. The age-standardized prevalence of hypertension was two times higher for those with higher education or high-income category. Compared to low-income and unemployed groups, the prevalence ratio of hypertension was 1.33 and 2.26 times more for those belonging to the high-income and employed groups, respectively. No evidence of mediation by lifestyle factors was observed between socioeconomic status and hypertension. CONCLUSIONS Socioeconomic positions were positively associated with hypertension prevalence in rural Nepal. Further studies using longitudinal settings are necessary to validate our findings especially in low- and middle-income countries such as Nepal.
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Affiliation(s)
- Sanju Bhattarai
- Department of Community Programs, Dhulikhel Hospital Kathmandu University Hospital, Dhulikhel, Nepal
| | - Birgit Tandstad
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Archana Shrestha
- Department of Public Health, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
- Institute of Implementation Science and Health, Kathmandu, Nepal
- Department of Chronic Disease Epidemiology Center of Methods for Implementation and Prevention Science, Yale School of Public Health, New Haven, USA
| | - Biraj Karmacharya
- Department of Public Health, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
- Institute of Implementation Science and Health, Kathmandu, Nepal
| | - Abhijit Sen
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
- Oral Health Services and Research Center, (TkMidt), Trondheim, Norway
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刘 秋, 陈 汐, 王 佳, 刘 晓, 司 亚, 梁 靖, 沈 鹏, 林 鸿, 唐 迅, 高 培. [Effectiveness of different screening strategies for cardiovascular diseases prevention in a community-based Chinese population: A decision-analytic Markov model]. BEIJING DA XUE XUE BAO. YI XUE BAN = JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2021; 53:460-466. [PMID: 34145845 PMCID: PMC8220034 DOI: 10.19723/j.issn.1671-167x.2021.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To evaluate the potential effectiveness of different screening strategies for cardiovascular diseases prevention in a community-based Chinese population from economically developed area of China. METHODS Totally 202 179 adults aged 40 to 74 years without cardiovascular diseases at baseline (January 1, 2010) were enrolled from the Chinese electronic health records research in Yinzhou (CHERRY) study. Three scenarios were considered: the screening strategy based on risk charts recommended by the 2020 Chinese guideline on the primary prevention of cardiovascular diseases in Chinese adults aged 40-74 years (Strategy 1); the screening strategy based on the prediction for atherosclerotic cardiovascular disease risk in China (China-PAR) models recommended by the 2019 Guideline on the assessment and management of cardiovascular risk in China in Chinese adults aged 40-74 years (Strategy 2); and the screening strategy based on the China-PAR models in Chinese adults aged 50-74 years (Strategy 3). According to the guidelines, individuals who were classified into medium- or high-risk groups after cardiovascular risk assessment by the corresponding strategies would be introduced to lifestyle intervention, while high-risk population would take medication in addition. Markov model was used to simulate different screening scenarios for 10 years (cycles), using parameters mainly from the CHERRY study, as well as published data, Meta-analyses and systematic reviews for Chinese populations. The life year gained, quality-adjusted life year (QALY) gained, number of cardiovascular disease events/deaths could be prevented and number needed to be screened (NNS) were calculated to compare the effectiveness between the different strategies. One-way sensitivity analysis on uncertainty of cardiovascular disease incidence rate and probabilistic sensitivity analysis on uncertainty of distributions for the hazard ratios were conducted. RESULTS Compared with non-screening strategy, QALYs gained were 1 433 [95% uncertainty interval (UI): 969-1 831], 1 401 (95%UI: 936-1 807), and 716 (95%UI: 265-1 111) for the Strategies 1, 2, and 3; and the NNS per QALY in the above strategies were 141 (95%UI: 110-209), 144 (95%UI: 112-216), and 198 (95%UI: 127-529), respectively. The Strategies 1 and 2 based on different guidelines showed similar effectiveness, while more benefits were found for screening using China-PAR models in adults aged 40-74 years than those aged 50-74 years. The results were consistent in the sensitivity analyses. CONCLUSION Screening for cardiovascular diseases in Chinese adults aged above 40 years seems effective in coastal developed areas of China, and the different screening strategies based on risk charts by the 2020 Chinese guideline on the primary prevention of cardiovascular diseases or China-PAR models by the 2019 Guideline on the assessment and management of cardiovascular risk in China may have similar effectiveness.
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Affiliation(s)
- 秋萍 刘
- 北京大学公共卫生学院流行病与卫生统计学系,北京 100191Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China
| | - 汐瑾 陈
- 北京大学临床研究所真实世界证据评价中心,北京 100191Center for Real-world Evidence Evaluation, Peking University Clinical Research Institute, Beijing 100191, China
| | - 佳敏 王
- 北京大学公共卫生学院流行病与卫生统计学系,北京 100191Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China
| | - 晓非 刘
- 北京大学临床研究所真实世界证据评价中心,北京 100191Center for Real-world Evidence Evaluation, Peking University Clinical Research Institute, Beijing 100191, China
| | - 亚琴 司
- 北京大学公共卫生学院流行病与卫生统计学系,北京 100191Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China
| | - 靖媛 梁
- 北京大学公共卫生学院流行病与卫生统计学系,北京 100191Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China
| | - 鹏 沈
- 宁波市鄞州区疾病预防控制中心,浙江宁波 315101Yinzhou District Center for Disease Control and Prevention, Ningbo 315101, Zhejiang, China
| | - 鸿波 林
- 宁波市鄞州区疾病预防控制中心,浙江宁波 315101Yinzhou District Center for Disease Control and Prevention, Ningbo 315101, Zhejiang, China
| | - 迅 唐
- 北京大学公共卫生学院流行病与卫生统计学系,北京 100191Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China
| | - 培 高
- 北京大学公共卫生学院流行病与卫生统计学系,北京 100191Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China
- 北京大学临床研究所真实世界证据评价中心,北京 100191Center for Real-world Evidence Evaluation, Peking University Clinical Research Institute, Beijing 100191, China
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21
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刘 秋, 陈 汐, 王 佳, 刘 晓, 司 亚, 梁 靖, 沈 鹏, 林 鸿, 唐 迅, 高 培. [Effectiveness of different screening strategies for cardiovascular diseases prevention in a community-based Chinese population: A decision-analytic Markov model]. BEIJING DA XUE XUE BAO. YI XUE BAN = JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2021; 53:460-466. [PMID: 34145845 PMCID: PMC8220034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Indexed: 11/08/2023]
Abstract
OBJECTIVE To evaluate the potential effectiveness of different screening strategies for cardiovascular diseases prevention in a community-based Chinese population from economically developed area of China. METHODS Totally 202 179 adults aged 40 to 74 years without cardiovascular diseases at baseline (January 1, 2010) were enrolled from the Chinese electronic health records research in Yinzhou (CHERRY) study. Three scenarios were considered: the screening strategy based on risk charts recommended by the 2020 Chinese guideline on the primary prevention of cardiovascular diseases in Chinese adults aged 40-74 years (Strategy 1); the screening strategy based on the prediction for atherosclerotic cardiovascular disease risk in China (China-PAR) models recommended by the 2019 Guideline on the assessment and management of cardiovascular risk in China in Chinese adults aged 40-74 years (Strategy 2); and the screening strategy based on the China-PAR models in Chinese adults aged 50-74 years (Strategy 3). According to the guidelines, individuals who were classified into medium- or high-risk groups after cardiovascular risk assessment by the corresponding strategies would be introduced to lifestyle intervention, while high-risk population would take medication in addition. Markov model was used to simulate different screening scenarios for 10 years (cycles), using parameters mainly from the CHERRY study, as well as published data, Meta-analyses and systematic reviews for Chinese populations. The life year gained, quality-adjusted life year (QALY) gained, number of cardiovascular disease events/deaths could be prevented and number needed to be screened (NNS) were calculated to compare the effectiveness between the different strategies. One-way sensitivity analysis on uncertainty of cardiovascular disease incidence rate and probabilistic sensitivity analysis on uncertainty of distributions for the hazard ratios were conducted. RESULTS Compared with non-screening strategy, QALYs gained were 1 433 [95% uncertainty interval (UI): 969-1 831], 1 401 (95%UI: 936-1 807), and 716 (95%UI: 265-1 111) for the Strategies 1, 2, and 3; and the NNS per QALY in the above strategies were 141 (95%UI: 110-209), 144 (95%UI: 112-216), and 198 (95%UI: 127-529), respectively. The Strategies 1 and 2 based on different guidelines showed similar effectiveness, while more benefits were found for screening using China-PAR models in adults aged 40-74 years than those aged 50-74 years. The results were consistent in the sensitivity analyses. CONCLUSION Screening for cardiovascular diseases in Chinese adults aged above 40 years seems effective in coastal developed areas of China, and the different screening strategies based on risk charts by the 2020 Chinese guideline on the primary prevention of cardiovascular diseases or China-PAR models by the 2019 Guideline on the assessment and management of cardiovascular risk in China may have similar effectiveness.
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Affiliation(s)
- 秋萍 刘
- 北京大学公共卫生学院流行病与卫生统计学系,北京 100191Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China
| | - 汐瑾 陈
- 北京大学临床研究所真实世界证据评价中心,北京 100191Center for Real-world Evidence Evaluation, Peking University Clinical Research Institute, Beijing 100191, China
| | - 佳敏 王
- 北京大学公共卫生学院流行病与卫生统计学系,北京 100191Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China
| | - 晓非 刘
- 北京大学临床研究所真实世界证据评价中心,北京 100191Center for Real-world Evidence Evaluation, Peking University Clinical Research Institute, Beijing 100191, China
| | - 亚琴 司
- 北京大学公共卫生学院流行病与卫生统计学系,北京 100191Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China
| | - 靖媛 梁
- 北京大学公共卫生学院流行病与卫生统计学系,北京 100191Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China
| | - 鹏 沈
- 宁波市鄞州区疾病预防控制中心,浙江宁波 315101Yinzhou District Center for Disease Control and Prevention, Ningbo 315101, Zhejiang, China
| | - 鸿波 林
- 宁波市鄞州区疾病预防控制中心,浙江宁波 315101Yinzhou District Center for Disease Control and Prevention, Ningbo 315101, Zhejiang, China
| | - 迅 唐
- 北京大学公共卫生学院流行病与卫生统计学系,北京 100191Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China
| | - 培 高
- 北京大学公共卫生学院流行病与卫生统计学系,北京 100191Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China
- 北京大学临床研究所真实世界证据评价中心,北京 100191Center for Real-world Evidence Evaluation, Peking University Clinical Research Institute, Beijing 100191, China
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22
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Cost-Effectiveness of Improved Hypertension Management in India through Increased Treatment Coverage and Adherence: A Mathematical Modeling Study. Glob Heart 2021; 16:37. [PMID: 34040950 PMCID: PMC8121007 DOI: 10.5334/gh.952] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background: Despite the availability of effective and affordable treatments, only 14% of hypertensive Indians have controlled blood pressure. Increased hypertension treatment coverage (the proportion of individuals initiated on treatment) and adherence (proportion of patients taking medicines as recommended) promise population health gains. However, governments and other payers will not invest in a large-scale hypertension control program unless it is both affordable and effective. Objective: To investigate if a national hypertension control intervention implemented across the private and public sector facilities in India could save overall costs of CVD prevention and treatment. Methods: We developed a discrete-time microsimulation model to assess the cost-effectiveness of population-level hypertension control intervention in India for combinations of treatment coverage and adherence targets. Input clinical parameters specific to India were obtained from large-scale surveys such as the Global Burden of Disease as well as local clinical trials. Input hypertensive medication cost parameters were based on government contracts. The model projected antihypertensive treatment costs, avoided CVD care costs, changes in disability-adjusted life year (DALYs) and incremental cost per DALY averted (represented as incremental cost-effectiveness ratio or ICER) over 20 years. Results: Over 20 years, at 70% coverage and adherence, the hypertension control intervention would avert 1.68% DALYs and be cost-saving overall. Increasing adherence (while keeping coverage constant) resulted in greater improvement in cost savings compared to increasing coverage (while keeping adherence constant). Results were most sensitive to the cost of antihypertensive medication, but the intervention remained highly cost-effective under all one-way sensitivity analyses. Conclusion: A national hypertension control intervention in India would most likely be budget neutral or cost-saving if the intervention can achieve and maintain high levels of both treatment coverage and adherence.
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23
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Li C, Chen K, Cornelius V, Tomeny E, Wang Y, Yang X, Yuan X, Qin R, Yu D, Wu Z, Wang D, Chen T. Applicability and cost-effectiveness of the Systolic Blood Pressure Intervention Trial (SPRINT) in the Chinese population: A cost-effectiveness modeling study. PLoS Med 2021; 18:e1003515. [PMID: 33661907 PMCID: PMC7971845 DOI: 10.1371/journal.pmed.1003515] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 03/18/2021] [Accepted: 02/02/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The Systolic Blood Pressure Intervention Trial (SPRINT) showed significant reductions in death and cardiovascular disease (CVD) risk with a systolic blood pressure (SBP) goal of <120 mm Hg compared with a SBP goal of <140 mm Hg. Our study aimed to assess the applicability of SPRINT to Chinese adults. Additionally, we sought to predict the medical and economic implications of this intensive SBP treatment among those meeting SPRINT eligibility. METHODS AND FINDINGS We used nationally representative baseline data from the China Health and Retirement Longitudinal Study (CHARLS) (2011-2012) to estimate the prevalence and number of Chinese adults aged 45 years and older who meet SPRINT criteria. A validated microsimulation model was employed to project costs, clinical outcomes, and quality-adjusted life-years (QALYs) among SPRINT-eligible adults, under 2 alternative treatment strategies (SBP goal of <120 mm Hg [intensive treatment] and SBP goal of <140 mm Hg [standard treatment]). Overall, 22.2% met the SPRINT criteria, representing 116.2 (95% CI 107.5 to 124.8) million people in China. Of these, 66.4%, representing 77.2 (95% CI 69.3 to 85.0) million, were not being treated for hypertension, and 22.9%, representing 26.6 (95% CI 22.4 to 30.7) million, had a SBP between 130 and 139 mm Hg, yet were not taking antihypertensive medication. We estimated that over 5 years, compared to standard treatment, intensive treatment would reduce heart failure incidence by 0.84 (95% CI 0.42 to 1.25) million cases, reduce CVD deaths by 2.03 (95% CI 1.44 to 2.63) million cases, and save 3.84 (95% CI 1.53 to 6.34) million life-years. Estimated reductions of 0.069 (95% CI -0.28, 0.42) million myocardial infarction cases and 0.36 (95% CI -0.10, 0.82) million stroke cases were not statistically significant. Furthermore, over a lifetime, moving from standard to intensive treatment increased the mean QALYs from 9.51 to 9.87 (an increment of 0.38 [95% CI 0.13 to 0.71]), at a cost of Int$10,997 per QALY gained. Of all 1-way sensitivity analyses, high antihypertensive drug cost and lower treatment efficacy for CVD death resulted in the 2 most unfavorable results (Int$25,291 and Int$18,995 per QALY were gained, respectively). Simulation results indicated that intensive treatment could be cost-effective (82.8% probability of being below the willingness-to-pay threshold of Int$16,782 [1× GDP per capita in China in 2017]), with a lower probability in people with SBP 130-139 mm Hg (72.9%) but a higher probability among females (91.2%). Main limitations include lack of specific SPRINT eligibility information in the CHARLS survey, uncertainty about the implications of different blood pressure measurement techniques, the use of several sources of data with large reliance on findings from SPPRINT, limited information about the serious adverse event rate, and lack of information and evidence for medication effectiveness on renal disease. CONCLUSIONS Although adoption of the SPRINT treatment strategy would increase the number of Chinese adults requiring SBP treatment intensification, this approach has the potential to prevent CVD events, to produce gains in life-years, and to be cost-effective under common thresholds.
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Affiliation(s)
- Chao Li
- Department of Epidemiology and Health Statistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, China
- Global Health Trials Unit, Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Kangyu Chen
- Department of Cardiology, First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Victoria Cornelius
- Imperial Clinical Trials Unit, School of Public Health, Imperial College London, London, United Kingdom
| | - Ewan Tomeny
- Centre for Applied Health Research & Delivery, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Yang Wang
- Medical Research and Biometrics Centre, Fuwai Hospital, National Centre for Cardiovascular Disease, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaowei Yang
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, China
| | - Xiaodan Yuan
- Department of Health Education, Jiangsu Province Hospital of Integration of Chinese and Western Medicine, Nanjing, China
| | - Rui Qin
- Department of Health Education, Jiangsu Province Hospital of Integration of Chinese and Western Medicine, Nanjing, China
| | - Dahai Yu
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, United Kingdom
| | - Zhenqiang Wu
- Department of Geriatric Medicine, University of Auckland, Auckland, New Zealand
| | - Duolao Wang
- Global Health Trials Unit, Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Tao Chen
- Department of Epidemiology and Health Statistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, China
- Global Health Trials Unit, Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- * E-mail:
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24
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Evaluation of blood pressure lowering effect by generic and brand-name antihypertensive drugs treatment: a multicenter prospective study in China. Chin Med J (Engl) 2021; 134:292-301. [PMID: 33470655 PMCID: PMC7846498 DOI: 10.1097/cm9.0000000000001360] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Generic drugs are bioequivalent to their brand-name counterparts; however, concerns still exist regarding the effectiveness and safety of generic drugs because of small sample sizes and short follow-up time in most studies. The purpose of this study was to evaluate the long-term antihypertensive efficacy, cost-effectiveness and cardiovascular outcomes of generic drugs compared with brand-name drugs. METHODS In a multicenter, community-based study including 7955 hypertensive patients who were prospectively followed up for an average of 2.5 years, we used the propensity-score-matching method to match the patients using brand-name drugs to those using generic drugs in a ratio of 1:2, 2176 patients using brand-name drugs and 4352 patients using generic drugs. RESULTS There were no significant differences between generic drugs and brand-name drugs in blood pressure (BP)-lowering efficacy, BP control rate, and cardiovascular outcomes including coronary heart disease and stroke. The adjusted mean (95% confidence interval [CI]) of systolic BP (SBP)-lowering was -7.9 mmHg (95% CI, -9.9 to -5.9) in the brand-name drug group and -7.1 mmHg (95% CI, -9.1 to -5.1) in the generic drug group after adjusting for age, sex, body mass index, number of antihypertensive drugs and traditionally cardiovascular risk factors. Among patients aged <60 years, brand-name drugs had a higher BP control rate (47% vs. 41%; P = 0.02) and a greater effect in lowering SBP compared with generic drugs, with the between-group difference of 1.5 mmHg (95% CI, 0.2-2.8; P = 0.03). BP control rate was higher in male patients using brand-name drugs compared with those using generic drugs (46% vs. 40%; P = 0.01). Generic drugs treatment yielded an average annual incremental cost-effectiveness ratio of $315.4 per patient per mmHg decrease in SBP compared with brand-name drugs treatment. CONCLUSIONS Our data suggested that generic drugs are suitable and cost-effective in improving hypertension management and facilitating public health benefits, especially in low- and middle-income areas.
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25
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Cong L, Ren Y, Hou T, Han X, Dong Y, Wang Y, Zhang Q, Liu R, Xu S, Wang L, Du Y, Qiu C. Use of Cardiovascular Drugs for Primary and Secondary Prevention of Cardiovascular Disease Among Rural-Dwelling Older Chinese Adults. Front Pharmacol 2020; 11:608136. [PMID: 33424613 PMCID: PMC7793651 DOI: 10.3389/fphar.2020.608136] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 11/23/2020] [Indexed: 12/23/2022] Open
Abstract
Cardiovascular risk factors and related disorders are common among older adults, and use of various classes of cardiovascular (CV) drugs could reduce the risk of cardiovascular disease (CVD). However, data are sparse with regard to the use of CV drugs among rural-dwelling older adults in China. Therefore, this population-based study aimed to describe use of CV drugs among older adults living in the rural communities in China, while taking into account the use of CV drugs for primary and secondary prevention of CVDs. This study included 5,246 participants (age ≥65 years; 57.17% women; 40.68% illiteracy) in the baseline examination of the MIND-China study. In March-September 2018, data on health-related factors, CVDs (ischemic heart disease, atrial fibrillation, heart failure, and stroke), and CV drug use were collected via face-to-face survey, clinical examination, and laboratory tests. We classified CV drugs according to the Anatomical Therapeutic Chemical classification system for western medications and specific cardiovascular effects for the products of traditional Chinese medicine (TCM). We conducted descriptive analysis. The overall prevalence of major cardiovascular risk factors ranged from 14.30% in diabetes and 23.81% in dyslipidemia to 66.70% in hypertension, and CVDs affected 35.07% of all participants (36.28% in women vs. 33.47% in men, p = 0.035). In the total sample, calcium channel blockers (C08) were most commonly used (10.39%), followed by TCM products (7.64%), hypoglycemic agents (A10, 4.73%), renin-angiotensin system (RAS)-acting agents (C09, 4.61%), and lipid-lowering agents (C10, 4.17%). The proportions of CV drugs for primary prevention (i.e., use of CV drugs among people without CVD) were 3.14% for antithrombotic agents (mainly aspirin), 1.38% for lipid-lowering agents, and 3.11% for RAS-acting agents; the corresponding figures for secondary prevention (i.e., use of CV drugs among people with CVD) were 13.97%, 9.35%, and 7.39%. In conclusion, despite highly prevalent cardiovascular risk factors and CVDs, a fairly low proportion of the rural-dwelling older adults take CV medications for primary and secondary prevention. Notably, TCM products are among the most commonly used CV drugs. These results call for additional efforts to promote implementation of the evidence-based recommendations for prevention of CVDs in the primary care settings.
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Affiliation(s)
- Lin Cong
- Department of Neurology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.,Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China.,Shandong Provincial Clinical Research Center for Neurological Diseases, Jinan, China
| | - Yifei Ren
- Department of Neurology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Tingting Hou
- Department of Neurology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.,Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China.,Shandong Provincial Clinical Research Center for Neurological Diseases, Jinan, China
| | - Xiaolei Han
- Department of Neurology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Yi Dong
- Department of Neurology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Yongxiang Wang
- Department of Neurology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.,Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China.,Shandong Provincial Clinical Research Center for Neurological Diseases, Jinan, China
| | - Qinghua Zhang
- Department of Neurology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.,Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China.,Shandong Provincial Clinical Research Center for Neurological Diseases, Jinan, China
| | - Rui Liu
- Department of Neurology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Shan Xu
- Department of Neurology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Lidan Wang
- Department of Neurology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Yifeng Du
- Department of Neurology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.,Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China.,Shandong Provincial Clinical Research Center for Neurological Diseases, Jinan, China
| | - Chengxuan Qiu
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China.,Aging Research Center and Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
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Jiang Y, Jiang S, Ni W. Burden of cardiovascular diseases associated with fine particulate matter in Beijing, China: an economic modelling study. BMJ Glob Health 2020; 5:bmjgh-2020-003160. [PMID: 33082134 PMCID: PMC7577033 DOI: 10.1136/bmjgh-2020-003160] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 09/07/2020] [Accepted: 09/09/2020] [Indexed: 11/06/2022] Open
Abstract
Objective To evaluate the economic and humanistic burden associated with cardiovascular diseases that were attributable to fine particulate matter (≤ 2.5 μg/m3 in aerodynamic diameter; PM2.5) in Beijing. Methods This study used a health economic modelling approach to compare the actual annual average PM2.5 concentration with the PM2.5 concentration limit (35 µg/m3) as defined by the Chinese Ambient Air Quality Standard in terms of cardiovascular disease outcomes in Beijing adult population. The outcomes included medical costs, quality-adjusted life-years (QALYs) and net monetary loss (NML). Beijing annual average PM2.5 concentration was around 105 µg/m3 during 2013–2015. Therefore, we estimated the differences in cardiovascular outcomes of Beijing adults between exposure to the PM2.5 concentration of 105 µg/m3 and exposure to the concentration of 35 µg/m3. According to WHO estimates, the hazard ratios of coronary heart disease and stroke associated with the increase of PM2.5 concentration from 35 to 105 µg/m3 were 1.15 and 1.29, respectively. Results The total 1-year excess medical costs of cardiovascular diseases associated with PM2.5 pollution in Beijing was US$147.9 million and the total 1-year QALY loss was 92 574 in 2015, amounting to an NML of US$2281.8 million. The expected lifetime incremental costs for a male Beijing adult and a female Beijing adult were US$237 and US$163, the corresponding QALY loss was 0.14 and 0.12, and the corresponding NML was US$3514 and US$2935. Conclusions PM2.5-related cardiovascular diseases imposed high economic and QALY burden on Beijing society. Continuous and intensive investment on reducing PM2.5 concentration is warranted even when only cardiovascular benefits are considered.
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Affiliation(s)
- Yawen Jiang
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, Guangdong, China
| | - Shan Jiang
- School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Weiyi Ni
- Department of Pharmaceutical and Health Economics, University of Southern California, Los Angeles, California, USA
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27
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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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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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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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30
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Abstract
Hypertension is the leading cause of cardiovascular disease and premature death worldwide. Owing to the widespread use of antihypertensive medications, global mean blood pressure (BP) has remained constant or has decreased slightly over the past four decades. By contrast, the prevalence of hypertension has increased, especially in low- and middle-income countries (LMICs). Estimates suggest that 31.1% of adults (1.39 billion) worldwide had hypertension in 2010. The prevalence of hypertension among adults was higher in LMICs (31.5%, 1.04 billion people) than in high-income countries (28.5%, 349 million people). Variations in the levels of risk factors for hypertension, such as high sodium intake, low potassium intake, obesity, alcohol consumption, physical inactivity and unhealthy diet, may explain some of the regional heterogeneity in hypertension prevalence. Despite the increasing prevalence, the proportions of hypertension awareness, treatment and BP control are low, particularly in LMICs, and few comprehensive assessments of the economic impact of hypertension exist. Future studies are warranted to test implementation strategies for hypertension prevention and control, especially in low-income populations, and to accurately assess the prevalence and financial burden of hypertension worldwide.
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Affiliation(s)
- Katherine T Mills
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
- Tulane University Translational Sciences Institute, New Orleans, LA, USA
| | - Andrei Stefanescu
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Jiang He
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA.
- Tulane University Translational Sciences Institute, New Orleans, LA, USA.
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31
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Xia S, Du X, Guo L, Du J, Arnott C, Lam CSP, Huffman MD, Arima H, Yuan Y, Zheng Y, Wu S, Guang X, Zhou X, Lin H, Cheng X, Anderson CS, Dong J, Ma C. Sex Differences in Primary and Secondary Prevention of Cardiovascular Disease in China. Circulation 2020; 141:530-539. [PMID: 32065775 DOI: 10.1161/circulationaha.119.043731] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Despite improvements in diagnostic and therapeutic interventions to combat cardiovascular disease (CVD) in recent decades, there are significant ongoing access gaps and sex disparities in prevention that have not been adequately quantified in China. METHODS A representative, cross-sectional, community-based survey of adults (aged ≥45 years) was conducted in 7 geographic regions of China between 2014 and 2016. Logistic regression models were used to determine sex differences in primary and secondary CVD prevention, and any interaction by age, education level, and area of residence. Data are presented as adjusted odds ratios (ORs) and 95% CIs. RESULTS Of 47 841 participants (61.3% women), 5454 (57.2% women) had established CVD and 9532 (70.5% women) had a high estimated 10-year CVD risk (≥10%). Only 48.5% and 48.6% of women and 39.3% and 59.8% of men were on any kind of blood pressure (BP)-lowering medication, lipid-lowering medication, or antiplatelet therapy for primary and secondary prevention, respectively. Women with established CVD were significantly less likely than men to receive BP-lowering medications (OR, 0.79 [95% CI, 0.65-0.95]), lipid-lowering medications (OR, 0.69 [95% CI, 0.56-0.84]), antiplatelets (OR, 0.53 [95% CI, 0.45-0.62]), or any CVD prevention medication (OR, 0.62 [95% CI, 0.52-0.73]). Women with established CVD, however, had better BP control (OR, 1.31 [95% CI, 1.14-1.50]) but less well-controlled low-density lipoprotein cholesterol (OR, 0.66 [95% CI, 0.57-0.76]), and were less likely to smoke (OR, 13.89 [95% CI, 11.24-17.15]) and achieve physical activity targets (OR, 1.92 [95% CI, 1.61-2.29]). Conversely, women with high CVD risk were less likely than men to have their BP, low-density lipoprotein cholesterol, and bodyweight controlled (OR, 0.46 [95% CI, 0.38-0.55]; OR, 0.60 [95% CI, 0.52-0.69]; OR, 0.55 [95% CI, 0.48-0.63], respectively), despite a higher use of BP-lowering medications (OR, 1.21 [95% CI, 1.01-1.45]). Younger patients (<65 years) with established CVD were less likely to be taking CVD preventive medications, but there were no sex differences by area of residence or education level. CONCLUSIONS Large and variable gaps in primary and secondary CVD prevention exist in China, particularly for women. Effective CVD prevention requires an improved overall nationwide strategy and a special emphasis on women with established CVD, who have the greatest disparity and the most to benefit.
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Affiliation(s)
- Shijun Xia
- Beijing Anzhen Hospital, Capital Medical University, China (S.X., X.D., L.G., J. Dong, C.M.)
| | - Xin Du
- Beijing Anzhen Hospital, Capital Medical University, China (S.X., X.D., L.G., J. Dong, C.M.).,Heart Health Research Centre, Beijing, China (X.D., C.S.A.).,The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia (X.D., C.A., C.S.P.L., M.D.H., C.S.A.)
| | - Lizhu Guo
- Beijing Anzhen Hospital, Capital Medical University, China (S.X., X.D., L.G., J. Dong, C.M.)
| | - Jing Du
- Beijing Centre for Disease Prevention and Control, China (J. Du)
| | - Clare Arnott
- Heart Health Research Centre, Beijing, China (X.D., C.S.A.).,The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia (X.D., C.A., C.S.P.L., M.D.H., C.S.A.).,Cardiology Department (C.A.), Royal Prince Alfred Hospital, Sydney, Australia.,Sydney Medical School, University of Sydney, Australia (C.A.)
| | - Carolyn S P Lam
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia (X.D., C.A., C.S.P.L., M.D.H., C.S.A.).,National Heart Centre Singapore and Duke-National University of Singapore (C.S.P.L.).,University Medical Centre Groningen, The Netherlands (C.S.P.L.)
| | - Mark D Huffman
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia (X.D., C.A., C.S.P.L., M.D.H., C.S.A.).,Northwestern University Feinberg School of Medicine, Chicago, IL (M.D.H.)
| | - Hisatomi Arima
- Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University, Japan (H.A.)
| | - Yiqiang Yuan
- The Seventh People's Hospital of Zhengzhou, Henan Province, China (Y.Y.)
| | - Yang Zheng
- Department of Cardiology, The First Hospital of Jilin University, Changchun, China (Y.Z.)
| | - Shulin Wu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China (S.W.)
| | - Xuefeng Guang
- Department of Cardiology, Yanan Hospital of Kunming, Kunming, Yunnan Province, China (X.G.)
| | - Xianhui Zhou
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumchi, Xinjiang Uyghur Autonomous Region, China (X.Z.)
| | - Hongbo Lin
- Yinzhou District Centre for Disease Control and Prevention, Ningbo, Zhejiang Province, China (H.L.)
| | - Xiaoshu Cheng
- Cardiovascular Department, The Second Affiliated Hospital of Nanchang University, Jiangxi Province, China (X.C.)
| | - Craig S Anderson
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia (X.D., C.A., C.S.P.L., M.D.H., C.S.A.).,Neurology Department (C.S.A.), Royal Prince Alfred Hospital, Sydney, Australia.,The George Institute China at Peking University Health Science Centre, China (C.S.A.)
| | - Jianzeng Dong
- Beijing Anzhen Hospital, Capital Medical University, China (S.X., X.D., L.G., J. Dong, C.M.).,The First Affiliated Hospital of Zhengzhou University, Henan Province, China (J. Dong)
| | - Changsheng Ma
- Beijing Anzhen Hospital, Capital Medical University, China (S.X., X.D., L.G., J. Dong, C.M.)
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32
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Pan Z, Xu W, Li Z, Xu C, Lu F, Zhang P, Zhang L, Ye T. Trajectories of Outpatient Service Utilisation of Hypertensive Patients in Tertiary Hospitals in China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17030852. [PMID: 32013261 PMCID: PMC7037428 DOI: 10.3390/ijerph17030852] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Revised: 01/21/2020] [Accepted: 01/25/2020] [Indexed: 12/30/2022]
Abstract
This study aims to identify the characteristics and trajectories of outpatient service utilisation for hypertensive patients in tertiary hospitals. This study also attempts to investigate the determinants of the trajectories of outpatient service utilisation. A total of 9822 patients with hypertension and hypertension-related medical utilisation were recruited in Yichang, China from January 1 to December 31 in 2016. The latent trajectories of outpatient service utilisation were identified through latent class growth analysis. Differences in the demographic characteristics and medical utilisation among patients in different trajectories were tested by one-way ANOVA and chi-square analysis. The predictors of the trajectory groups of outpatient service utilisation were identified through multinomial logistic regression. Four trajectory groups were determined as stable-low (34.7%), low-fluctuating (13.4%), high-fluctuating (22.5%), and stable-high (29.4%). Significant differences were observed in all demographic characteristics (p < 0.001) and medical service utilisation variables (p < 0.001) among the four trajectories except for inpatient cost (p = 0.072). Determinants for outpatient service utilisation patterns include the place of residence, education level, outpatient visit times, inpatient service utilisation, and outpatient cost. Overall, hypertensive patients visiting outpatient units in the tertiary hospital were middle-aged, elderly, and well-educated, and they received poor follow-up services. The four identified latent trajectories have different characteristics and medical utilisation patterns. Trajectory group-based measurements are necessary for hypertension management and economic burden reduction.
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Affiliation(s)
- Zijing Pan
- School of Medicine and Health Management, Huazhong University of Science and Technology, Wuhan 430030, China; (Z.P.); (W.X.); (Z.L.); (L.Z.)
- Research Centre for Rural Health Service, Key Research Institute of Humanities & Social Sciences of Hubei Provincial Department of Education, Wuhan 430030, China
| | - Wanchun Xu
- School of Medicine and Health Management, Huazhong University of Science and Technology, Wuhan 430030, China; (Z.P.); (W.X.); (Z.L.); (L.Z.)
- Research Centre for Rural Health Service, Key Research Institute of Humanities & Social Sciences of Hubei Provincial Department of Education, Wuhan 430030, China
| | - Zhong Li
- School of Medicine and Health Management, Huazhong University of Science and Technology, Wuhan 430030, China; (Z.P.); (W.X.); (Z.L.); (L.Z.)
- Research Centre for Rural Health Service, Key Research Institute of Humanities & Social Sciences of Hubei Provincial Department of Education, Wuhan 430030, China
| | - Chengzhong Xu
- Yichang Centre for Disease Control and Prevention, Yichang 443000, China; (C.X.); (F.L.); (P.Z.)
| | - Fangfang Lu
- Yichang Centre for Disease Control and Prevention, Yichang 443000, China; (C.X.); (F.L.); (P.Z.)
| | - Pei Zhang
- Yichang Centre for Disease Control and Prevention, Yichang 443000, China; (C.X.); (F.L.); (P.Z.)
| | - Liang Zhang
- School of Medicine and Health Management, Huazhong University of Science and Technology, Wuhan 430030, China; (Z.P.); (W.X.); (Z.L.); (L.Z.)
- Research Centre for Rural Health Service, Key Research Institute of Humanities & Social Sciences of Hubei Provincial Department of Education, Wuhan 430030, China
| | - Ting Ye
- School of Medicine and Health Management, Huazhong University of Science and Technology, Wuhan 430030, China; (Z.P.); (W.X.); (Z.L.); (L.Z.)
- Research Centre for Rural Health Service, Key Research Institute of Humanities & Social Sciences of Hubei Provincial Department of Education, Wuhan 430030, China
- Correspondence:
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33
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Zhao Y, Mahal AS, Haregu TN, Katar A, Oldenburg B, Zhang L. Trends and Inequalities in the Health Care and Hypertension Outcomes in China, 2011 to 2015. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16224578. [PMID: 31752338 PMCID: PMC6888605 DOI: 10.3390/ijerph16224578] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Revised: 11/06/2019] [Accepted: 11/09/2019] [Indexed: 12/27/2022]
Abstract
Background: Hypertension is one of the most significant and common risk factors for cardiovascular disease, yet it remains poorly controlled in China. This study aims to examine trends and socioeconomic inequalities in the management of hypertension between 2011 and 2015 in China and to investigate the association between antihypertensive medication treatment and reduction of blood pressure, using nationally representative data. Methods: Concentration curve and concentration index were used to assess socioeconomic-related inequalities in hypertension care and health service utilisation. The fixed-effects analysis was performed to measure the impact of medication treatment on reduction of blood pressure among people with hypertension by using linear regression models. Results: Among hypertensive individuals, there were growing trends in the rates of awareness and treatment from 55.87% and 48.44% in 2011, to 68.31% in 2013 and 61.97% in 2015, respectively. The proportion of hypertension control was still below 30%. The fixed-effects models indicated that medication treatment was statistically significant and associated with the patients' systolic blood pressure (β: -13.483; 95% CI: -15.672, -11.293) and diastolic blood pressure (β: -5.367; 95% CI: -6.390, -4.344). Conclusions: China has made good progress in the hypertension diagnosis, medication treatment and coverage of health services over the last 10 years; however, pro-rich inequalities in hypertension care still exist, and there is considerable progress to be made in the prevention, treatment and effective control of hypertension.
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Affiliation(s)
- Yang Zhao
- The Nossal Institute for Global Health, The University of Melbourne, Melbourne 3010, Australia; (Y.Z.); (A.S.M.); (T.N.H.); (A.K.); (B.O.)
- WHO Collaborating Centre on Implementation Research for Prevention & Control of NCDs, Melbourne 3010, Australia
| | - Ajay Singh Mahal
- The Nossal Institute for Global Health, The University of Melbourne, Melbourne 3010, Australia; (Y.Z.); (A.S.M.); (T.N.H.); (A.K.); (B.O.)
| | - Tilahun Nigatu Haregu
- The Nossal Institute for Global Health, The University of Melbourne, Melbourne 3010, Australia; (Y.Z.); (A.S.M.); (T.N.H.); (A.K.); (B.O.)
- WHO Collaborating Centre on Implementation Research for Prevention & Control of NCDs, Melbourne 3010, Australia
| | - Ameera Katar
- The Nossal Institute for Global Health, The University of Melbourne, Melbourne 3010, Australia; (Y.Z.); (A.S.M.); (T.N.H.); (A.K.); (B.O.)
| | - Brian Oldenburg
- The Nossal Institute for Global Health, The University of Melbourne, Melbourne 3010, Australia; (Y.Z.); (A.S.M.); (T.N.H.); (A.K.); (B.O.)
- WHO Collaborating Centre on Implementation Research for Prevention & Control of NCDs, Melbourne 3010, Australia
| | - Luwen Zhang
- School of Health Services Management, Southern Medical University, Guangzhou 500000, Guangdong, China
- Correspondence:
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34
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Zhao Y, Oldenburg B, Zhao S, Haregu TN, Zhang L. Temporal Trends and Geographic Disparity in Hypertension Care in China. J Epidemiol 2019; 30:354-361. [PMID: 31327817 PMCID: PMC7348077 DOI: 10.2188/jea.je20190029] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND This study examines trends and geographic disparities in the diagnosis, treatment, and control of hypertension in China and investigates the association between regional factors and hypertension care. METHODS Blood pressure data and data relating to health care for hypertension were used for this study. The data were sourced from baseline and follow-up surveys of the China Health and Retirement Longitudinal Study, which was conducted in 2011, 2013, and 2015. To estimate the geographical disparities in diagnosis, treatment, and control of hypertension, random-effects models were also applied after controlling for sociodemographic characteristics. RESULTS Among hypertensive individuals in China, the trends showed decreases in undiagnosed, untreated, and uncontrolled hypertension: 44.1%, 51.6%, and 80.7% in 2011; 40.0%, 47.4%, and 77.8% in 2013; and 31.7%, 38.0%, and 71.4% in 2015, respectively. The number of undiagnosed, untreated, and uncontrolled hypertensive residents living in urban areas in 2015 was more than 10% lower than the number in rural areas and among rural-to-urban immigrant individuals in China. The poorest socio-economic regions across China were 8.5 times more likely to leave their residents undiagnosed, 2.8 times more likely to leave them untreated, and 2.6 times more likely to leave hypertension uncontrolled. CONCLUSIONS Although China has made impressive progress in addressing regional inequalities in hypertension care over time, it needs to increase its effort to reduce geographic disparities and to provide more effective treatments and higher quality care for patients with hypertension.
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Affiliation(s)
- Yang Zhao
- Melbourne School of Population and Global Health, The University of Melbourne.,WHO Collaborating Centre on Implementation Research for Prevention & Control of NCDs
| | - Brian Oldenburg
- Melbourne School of Population and Global Health, The University of Melbourne.,WHO Collaborating Centre on Implementation Research for Prevention & Control of NCDs
| | - Siqi Zhao
- Yantaishan Hospital of Yantai.,Yantai Sino-French Friendship Hospital
| | | | - Luwen Zhang
- School of Health Services Management, Southern Medical University
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35
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Chen S, Sudharsanan N, Huang F, Liu Y, Geldsetzer P, Bärnighausen T. Impact of community based screening for hypertension on blood pressure after two years: regression discontinuity analysis in a national cohort of older adults in China. BMJ 2019; 366:l4064. [PMID: 31296584 PMCID: PMC6619453 DOI: 10.1136/bmj.l4064] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To estimate the causal impact of community based blood pressure screening on subsequent blood pressure levels among older adults in China. DESIGN Regression discontinuity analysis using data from a national cohort study. SETTING 2011-12 and 2014 waves of the Chinese Longitudinal Healthy Longevity Survey, a national cohort of older adults in China. PARTICIPANTS 3899 older adults who had previously undiagnosed hypertension. INTERVENTION Community based hypertension screening among older adults in 2011-12. MAIN OUTCOME MEASURE Blood pressure two years after initial screening. RESULTS The intervention reduced systolic blood pressure: -6.3 mm Hg in the model without covariates (95% confidence interval -11.2 to -1.3) and -8.3 mm Hg (-13.6 to -3.1) in the model that adjusts additionally for demographic, social, and behavioural covariates. The impact on diastolic blood pressure was smaller and non-significant in all models. The results were similar when alternative functional forms were used to estimate the impact and the bandwidths around the intervention threshold were changed. The results did not vary by demographic and social subgroups. CONCLUSIONS Community based hypertension screening and encouraging people with raised blood pressure to seek care and adopt blood pressure lowering behaviour changes could have important long term impact on systolic blood pressure at the population level. This approach could address the high burden of cardiovascular diseases in China and other countries with large unmet need for hypertension diagnosis and care.
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Affiliation(s)
- Simiao Chen
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, 69120 Heidelberg, Germany
| | - Nikkil Sudharsanan
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, 69120 Heidelberg, Germany
- Harvard Center for Population and Development Studies, Harvard T H Chan School of Public Health, Cambridge, MA, USA
| | - Feng Huang
- School of Economics and Key Laboratory of Mathematical Economics, Shanghai University of Finance and Economics, Shanghai, China
| | - Yuanli Liu
- School of Public Health, Peking Union Medical College, Beijing, China
| | - Pascal Geldsetzer
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Till Bärnighausen
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, 69120 Heidelberg, Germany
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
- Africa Health Research Institute, Somkhele, KwaZulu-Natal, South Africa
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36
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Jiang Y, Ni W. Economic Evaluation of the 2016 Chinese Guideline and Alternative Risk Thresholds of Initiating Statin Therapy for the Management of Atherosclerotic Cardiovascular Disease. PHARMACOECONOMICS 2019; 37:943-952. [PMID: 30875022 DOI: 10.1007/s40273-019-00791-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE The 2016 Chinese guidelines for the management of dyslipidemia recommended mixed rules that centered around a 10% 10-year risk threshold to initiate statins for the primary prevention of atherosclerotic cardiovascular disease (ASCVD). The present study aimed to evaluate the cost-effectiveness of the guideline statin-initiation strategy and alternative strategies. METHODS A decision analytic model using discrete event simulation with event probabilities based on a validated ASCVD risk prediction tool for Chinese was constructed. Risk factor inputs were from the dataset of a nationally representative survey of middle-aged and elderly Chinese. Data of statin treatment effectiveness were from a published meta-analysis. Other key input data were identified from the literature or relevant databases. The strategies we evaluated were the guideline strategy, a 15% 10-year risk threshold strategy and a 20% 10-year risk threshold strategy. After excluding any extended dominance strategies, the incremental costs per quality-adjusted life year (QALY) gained of each strategy was calculated. RESULTS The 20% 10-year risk threshold strategy was an extended dominance option. The incremental costs per QALY gained from the 15% 10-year risk threshold strategy compared with no treatment and the guideline strategy compared with the 15% 10-year risk threshold strategy were CN¥69,309 and CN¥154,944, respectively. The results were robust in most sensitivity analyses. CONCLUSIONS The guideline strategy and the 15% 10-year risk threshold strategy are optimal when using the three times and the two times the gross domestic product per capita willingness-to-pay standards, respectively.
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Affiliation(s)
- Yawen Jiang
- Department of Pharmaceutical and Health Economics, University of Southern California, USC Schaeffer Center, 635 Downey Way, Verna and Peter Dauterive Hall (VPD), Suite 210, Los Angeles, CA, 90089-3333, USA.
| | - Weiyi Ni
- Department of Pharmaceutical and Health Economics, University of Southern California, USC Schaeffer Center, 635 Downey Way, Verna and Peter Dauterive Hall (VPD), Suite 210, Los Angeles, CA, 90089-3333, USA
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McGurgan IJ, Clarke R, Lacey B, Kong XL, Chen Z, Chen Y, Guo Y, Bian Z, Li L, Lewington S. Blood Pressure and Risk of Subarachnoid Hemorrhage in China. Stroke 2019; 50:38-44. [PMID: 30580702 PMCID: PMC6314500 DOI: 10.1161/strokeaha.118.022239] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 10/11/2018] [Accepted: 10/31/2018] [Indexed: 11/16/2022]
Abstract
Background and Purpose- Subarachnoid hemorrhage (SAH) has a high case fatality rate and young mean age at onset compared with other types of stroke, but the pathogenesis of SAH is not fully understood. We examined associations of systolic and diastolic blood pressure with incident nontraumatic SAH in a large prospective study in China. Methods- In 2004 to 2008, 512 891 adults (59% women) from the general population were recruited into the CKB study (China Kadoorie Biobank). Participants were interviewed, measured, and followed up for fatal and nonfatal events. After excluding those with prior vascular disease, Cox regression analysis was used to relate blood pressure to incident SAH events. Analyses were adjusted for major confounders and corrected for regression dilution to give associations with long-term average blood pressure. Results- At baseline, mean age was 51 (SD, 11) years, and mean systolic blood pressure/diastolic blood pressure was 130.6/77.6 (SD, 21.0/11.1) mm Hg. During 3.5 million person-years of follow-up, there were 553 incident SAH cases (mean age at event, 61 [SD, 11] years), yielding an overall annual incidence rate of 12.9 per 100 000. Higher average levels of blood pressure were linearly and positively associated with higher risks of incident SAH: a 10 mm Hg higher systolic blood pressure and a 5 mm Hg higher diastolic blood pressure were associated with hazard ratios for SAH of 1.21 (95% CI, 1.13-1.29) and 1.20 (95% CI, 1.12-1.28), respectively. There was no evidence that the hazard ratios varied by age or sex or by levels of other vascular risk factors. Elevated blood pressure (systolic blood pressure, >120 mm Hg) accounted for 23% of all SAH cases. Conclusions- The incidence of SAH in China was comparable with estimates from Western populations. Higher levels of blood pressure were positively associated with higher risks of SAH, and elevated blood pressure accounted for about a quarter of all SAH cases.
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Affiliation(s)
- Iain John McGurgan
- From the Nuffield Department of Population Health (I.J.M., R.C., B.L., X.L.K., Z.C., Y.C., S.L.), University of Oxford, United Kingdom
| | - Robert Clarke
- From the Nuffield Department of Population Health (I.J.M., R.C., B.L., X.L.K., Z.C., Y.C., S.L.), University of Oxford, United Kingdom
| | - Ben Lacey
- From the Nuffield Department of Population Health (I.J.M., R.C., B.L., X.L.K., Z.C., Y.C., S.L.), University of Oxford, United Kingdom
- Medical Research Council Population Health Research Unit, Nuffield Department of Population Health (B.L., X.L.K., S.L.), University of Oxford, United Kingdom
| | - Xiang Ling Kong
- From the Nuffield Department of Population Health (I.J.M., R.C., B.L., X.L.K., Z.C., Y.C., S.L.), University of Oxford, United Kingdom
- Medical Research Council Population Health Research Unit, Nuffield Department of Population Health (B.L., X.L.K., S.L.), University of Oxford, United Kingdom
| | - Zhengming Chen
- From the Nuffield Department of Population Health (I.J.M., R.C., B.L., X.L.K., Z.C., Y.C., S.L.), University of Oxford, United Kingdom
| | - Yiping Chen
- From the Nuffield Department of Population Health (I.J.M., R.C., B.L., X.L.K., Z.C., Y.C., S.L.), University of Oxford, United Kingdom
| | - Yu Guo
- Chinese Academy of Medical Sciences, Beijing, China (Y.G., Z.B., L.L.)
| | - Zheng Bian
- Chinese Academy of Medical Sciences, Beijing, China (Y.G., Z.B., L.L.)
| | - Liming Li
- Chinese Academy of Medical Sciences, Beijing, China (Y.G., Z.B., L.L.)
- Department of Epidemiology, School of Public Health, Peking University Health Science Center, Beijing, China (L.L.)
| | - Sarah Lewington
- From the Nuffield Department of Population Health (I.J.M., R.C., B.L., X.L.K., Z.C., Y.C., S.L.), University of Oxford, United Kingdom
- Medical Research Council Population Health Research Unit, Nuffield Department of Population Health (B.L., X.L.K., S.L.), University of Oxford, United Kingdom
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Moses MW, Pedroza P, Baral R, Bloom S, Brown J, Chapin A, Compton K, Eldrenkamp E, Fullman N, Mumford JE, Nandakumar V, Rosettie K, Sadat N, Shonka T, Flaxman A, Vos T, Murray CJL, Weaver MR. Funding and services needed to achieve universal health coverage: applications of global, regional, and national estimates of utilisation of outpatient visits and inpatient admissions from 1990 to 2016, and unit costs from 1995 to 2016. LANCET PUBLIC HEALTH 2018; 4:e49-e73. [PMID: 30551974 PMCID: PMC6323358 DOI: 10.1016/s2468-2667(18)30213-5] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 10/18/2018] [Indexed: 01/11/2023]
Abstract
BACKGROUND To inform plans to achieve universal health coverage (UHC), we estimated utilisation and unit cost of outpatient visits and inpatient admissions, did a decomposition analysis of utilisation, and estimated additional services and funds needed to meet a UHC standard for utilisation. METHODS We collated 1175 country-years of outpatient data on utilisation from 130 countries and 2068 country-years of inpatient data from 128 countries. We did meta-regression analyses of annual visits and admissions per capita by sex, age, location, and year with DisMod-MR, a Bayesian meta-regression tool. We decomposed changes in total number of services from 1990 to 2016. We used data from 795 National Health Accounts to estimate shares of outpatient and inpatient services in total health expenditure by location and year and estimated unit costs as expenditure divided by utilisation. We identified standards of utilisation per disability-adjusted life-year and estimated additional services and funds needed. FINDINGS In 2016, the global age-standardised outpatient utilisation rate was 5·42 visits (95% uncertainty interval [UI] 4·88-5·99) per capita and the inpatient utilisation rate was 0·10 admissions (0·09-0·11) per capita. Globally, 39·35 billion (95% UI 35·38-43·58) visits and 0·71 billion (0·65-0·77) admissions were provided in 2016. Of the 58·65% increase in visits since 1990, population growth accounted for 42·95%, population ageing for 8·09%, and higher utilisation rates for 7·63%; results for the 67·96% increase in admissions were 44·33% from population growth, 9·99% from population ageing, and 13·55% from increases in utilisation rates. 2016 unit cost estimates (in 2017 international dollars [I$]) ranged from I$2 to I$478 for visits and from I$87 to I$22 543 for admissions. The annual cost of 8·20 billion (6·24-9·95) additional visits and 0·28 billion (0·25-0·30) admissions in low-income and lower-middle income countries in 2016 was I$503·12 billion (404·35-605·98) or US$158·10 billion (126·58-189·67). INTERPRETATION UHC plans can be based on utilisation and unit costs of current health systems and guided by standards of utilisation of outpatient visits and inpatient admissions that achieve the highest coverage of personal health services at the lowest cost. FUNDING Bill & Melinda Gates Foundation.
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Affiliation(s)
- Mark W Moses
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Paola Pedroza
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | | | - Sabina Bloom
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Jonathan Brown
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Abby Chapin
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Kelly Compton
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Erika Eldrenkamp
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Nancy Fullman
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - John Everett Mumford
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Vishnu Nandakumar
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Katherine Rosettie
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Nafis Sadat
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Tom Shonka
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Abraham Flaxman
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Theo Vos
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Chris J L Murray
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Marcia R Weaver
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
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Augustovski F, Chaparro M, Palacios A, Shi L, Beratarrechea A, Irazola V, Rubinstein A, Mills K, He J, Pichon Riviere A. Cost-Effectiveness of a Comprehensive Approach for Hypertension Control in Low-Income Settings in Argentina: Trial-Based Analysis of the Hypertension Control Program in Argentina. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2018; 21:1357-1364. [PMID: 30502778 PMCID: PMC6457112 DOI: 10.1016/j.jval.2018.06.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 05/07/2018] [Accepted: 06/08/2018] [Indexed: 05/09/2023]
Abstract
BACKGROUND A recent cluster randomized trial evaluating a multicomponent intervention showed significant reductions in blood pressure in low-income hypertensive subjects in Argentina. OBJECTIVES To assess the cost-effectiveness of this intervention. METHODS A total of 1432 hypertensive participants were recruited from 18 primary health care centers. The intervention included home visits led by community health workers, physician education, and text messaging. Resource use and quality of life data using the three-level EuroQol five-dimensional questionnaire were prospectively collected. The study perspective was that of the public health care system, and the time horizon was 18 months. Intention-to-treat analysis was used to analyze cost and health outcomes (systolic blood pressure [SBP] change and quality-adjusted life-years [QALYs]). A 1 time gross domestic product per capita per QALY was used as the cost-effectiveness threshold (US $14,062). RESULTS Baseline characteristics were similar in the two arms. QALYs significantly increased by 0.06 (95% confidence interval [CI] 0.04-0.09) in the intervention group, and SBP net difference favored the intervention group: 5.3 mm Hg (95% CI 0.27-10.34). Mean total costs per participant were higher in the intervention arm: US $304 in the intervention group and US $154 in the control group (adjusted difference of US $140.18; 95% CI US $75.41-US $204.94). The incremental cost-effectiveness ratio was $3299 per QALY (95% credible interval 1635-6099) and US $26 per mm Hg of SBP (95% credible interval 13-46). Subgroup analysis showed that the intervention was cost-effective in all prespecified subgroups (age, sex, cardiovascular risk, and body mass index). CONCLUSIONS The multicomponent intervention was cost-effective for blood pressure control among low-income hypertensive patients.
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Affiliation(s)
- Federico Augustovski
- Institute for Clinical Effectiveness and Health Policy (IECS/CONICET), Buenos Aires, Argentina; School of Public Health, University of Buenos Aires, Buenos Aires, Argentina.
| | - Martín Chaparro
- Institute for Clinical Effectiveness and Health Policy (IECS/CONICET), Buenos Aires, Argentina
| | - Alfredo Palacios
- Institute for Clinical Effectiveness and Health Policy (IECS/CONICET), Buenos Aires, Argentina
| | - Lizheng Shi
- Department of Global Health Management and Policy, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Andrea Beratarrechea
- Institute for Clinical Effectiveness and Health Policy (IECS/CONICET), Buenos Aires, Argentina
| | - Vilma Irazola
- Institute for Clinical Effectiveness and Health Policy (IECS/CONICET), Buenos Aires, Argentina
| | - Adolfo Rubinstein
- Institute for Clinical Effectiveness and Health Policy (IECS/CONICET), Buenos Aires, Argentina; School of Public Health, University of Buenos Aires, Buenos Aires, Argentina
| | - Katherine Mills
- Department of Epidemiology and Tulane University Translational Science Institute, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Jiang He
- Department of Epidemiology and Tulane University Translational Science Institute, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Andrés Pichon Riviere
- Institute for Clinical Effectiveness and Health Policy (IECS/CONICET), Buenos Aires, Argentina; School of Public Health, University of Buenos Aires, Buenos Aires, Argentina
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Thomas H, Diamond J, Vieco A, Chaudhuri S, Shinnar E, Cromer S, Perel P, Mensah GA, Narula J, Johnson CO, Roth GA, Moran AE. Global Atlas of Cardiovascular Disease 2000-2016: The Path to Prevention and Control. Glob Heart 2018; 13:143-163. [PMID: 30301680 DOI: 10.1016/j.gheart.2018.09.511] [Citation(s) in RCA: 185] [Impact Index Per Article: 30.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
- Hana Thomas
- Heilbrunn Department of Population & Family Health, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Jamie Diamond
- Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - Adrianna Vieco
- Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - Shaoli Chaudhuri
- Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - Eliezer Shinnar
- Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - Sara Cromer
- Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - Pablo Perel
- World Heart Federation, Geneva, Switzerland; London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - George A Mensah
- Center for Translation Research and Implementation Science, United States National Heart, Lung, and Blood Institute, Bethesda, MD, USA
| | - Jagat Narula
- Division of Cardiology, Mount Sinai Medical Center, New York, NY, USA
| | - Catherine O Johnson
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Gregory A Roth
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Division of Cardiology, University of Washington, Seattle, WA, USA
| | - Andrew E Moran
- Department of Medicine, Columbia University Medical Center, New York, NY, USA; Division of General Medicine, Columbia University, New York, NY, USA.
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Aminde LN, Takah NF, Zapata-Diomedi B, Veerman JL. Primary and secondary prevention interventions for cardiovascular disease in low-income and middle-income countries: a systematic review of economic evaluations. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2018; 16:22. [PMID: 29983644 PMCID: PMC6003072 DOI: 10.1186/s12962-018-0108-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 06/09/2018] [Indexed: 12/12/2022] Open
Abstract
Background Cardiovascular disease (CVD) is the leading cause of deaths globally, with greatest premature mortality in the low- and middle-income countries (LMIC). Many of these countries, especially in sub-Saharan Africa, have significant budget constraints. The need for current evidence on which interventions offer good value for money to stem this CVD epidemic motivates this study. Methods In this systematic review, we included studies reporting full economic evaluations of individual and population-based interventions (pharmacologic and non-pharmacologic), for primary and secondary prevention of CVD among adults in LMIC. Several medical (PubMed, EMBASE, SCOPUS, Web of Science) and economic (EconLit, NHS EED) databases and grey literature were searched. Screening of studies and data extraction was done independently by two reviewers. Drummond’s checklist and the National Institute for Health and Care Excellence quality rating scale were used in the quality appraisal for all studies used to inform this evidence synthesis. Results From a pool of 4059 records, 94 full texts were read and 50 studies, which met our inclusion criteria, were retained for our narrative synthesis. Most of the studies were from middle-income countries and predominantly of high quality. The majority were modelled evaluations, and there was significant heterogeneity in methods. Primary prevention studies dominated secondary prevention. Most of the economic evaluations were performed for pharmacological interventions focusing on blood pressure, cholesterol lowering and antiplatelet aggregants. The greatest majority were cost-effective. Compared to individual-based interventions, population-based interventions were few and mostly targeted reduction in sodium intake and tobacco control strategies. These were very cost-effective with many being cost-saving. Conclusions This evidence synthesis provides a contemporary update on interventions that offer good value for money in LMICs. Population-based interventions especially those targeting reduction in salt intake and tobacco control are very cost-effective in LMICs with potential to generate economic gains that can be reinvested to improve health and/or other sectors. While this evidence is relevant for policy across these regions, decision makers should additionally take into account other multi-sectoral perspectives, including considerations in budget impact, fairness, affordability and implementation while setting priorities for resource allocation. Electronic supplementary material The online version of this article (10.1186/s12962-018-0108-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Leopold Ndemnge Aminde
- 1Faculty of Medicine, School of Public Health, The University of Queensland, Brisbane, QLD 4006 Australia.,Non-communicable Diseases Unit, Clinical Research Education, Network & Consultancy, Douala, Cameroon
| | | | - Belen Zapata-Diomedi
- 1Faculty of Medicine, School of Public Health, The University of Queensland, Brisbane, QLD 4006 Australia
| | - J Lennert Veerman
- 1Faculty of Medicine, School of Public Health, The University of Queensland, Brisbane, QLD 4006 Australia.,4School of Medicine, Griffith University, Gold Coast, QLD 4222 Australia.,5Cancer Research Division, Cancer Council NSW, Woolloomooloo, NSW 2011 Australia
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Abstract
China has the largest population of adults with hypertension in the world. Recent clinical trials have shown that intensive hypertension control can help patients achieve lower blood pressure and reduce the incidence of major cardiovascular disease (CVD) events, but this level of hypertension control also incurs additional costs to patients and society and may result in a substantial increase in adverse events. The objective of this study is to assess the cost-effectiveness of intensive hypertension control to inform health policymakers and health care delivery systems in China in their decision-making regarding hypertension treatment strategies. We developed a Markov based simulation model of hypertension to assess the impact of intensive and standard hypertension control strategies for the Chinese population who are diagnosed with hypertension. Model parameters were estimated based on the best available data and the literature. We projected that intensive hypertension control would avert about 2.2 million coronary heart disease events and 4.4 million stroke events for all hypertensive patients in China in 10 years compared to standard hypertension control. The incremental cost-effectiveness ratio (ICER) for intensive hypertension control was estimated at 7876 CNY per quality-adjusted life year (QALY) compared to standard hypertension control. Intensive hypertension control would be more cost-effective than standard hypertension control in China. Our findings indicated that China should consider expanding intensive hypertension control among hypertensive patients given its great potential in preventing CVD.
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Lacey B, Lewington S, Clarke R, Kong XL, Chen Y, Guo Y, Yang L, Bennett D, Bragg F, Bian Z, Wang S, Zhang H, Chen J, Walters RG, Collins R, Peto R, Li L, Chen Z. Age-specific association between blood pressure and vascular and non-vascular chronic diseases in 0·5 million adults in China: a prospective cohort study. Lancet Glob Health 2018; 6:e641-e649. [PMID: 29773120 PMCID: PMC5960069 DOI: 10.1016/s2214-109x(18)30217-1] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 02/22/2018] [Accepted: 03/27/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND The age-specific association between blood pressure and vascular disease has been studied mostly in high-income countries, and before the widespread use of brain imaging for diagnosis of the main stroke types (ischaemic stroke and intracerebral haemorrhage). We aimed to investigate this relationship among adults in China. METHODS 512 891 adults (59% women) aged 30-79 years were recruited into a prospective study from ten areas of China between June 25, 2004, and July 15, 2008. Participants attended assessment centres where they were interviewed about demographic and lifestyle characteristics, and their blood pressure, height, and weight were measured. Incident disease was identified through linkage to local mortality records, chronic disease registries, and claims to the national health insurance system. We used Cox regression analysis to produce adjusted hazard ratios (HRs) relating systolic blood pressure to disease incidence. HRs were corrected for regression dilution to estimate associations with long-term average (usual) systolic blood pressure. FINDINGS During a median follow-up of 9 years (IQR 8-10), there were 88 105 incident vascular and non-vascular chronic disease events (about 90% of strokes events were diagnosed using brain imaging). At ages 40-79 years (mean age at event 64 years [SD 9]), usual systolic blood pressure was continuously and positively associated with incident major vascular disease throughout the range 120-180 mm Hg: each 10 mm Hg higher usual systolic blood pressure was associated with an approximately 30% higher risk of ischaemic heart disease (HR 1·31 [95% CI 1·28-1·34]) and ischaemic stroke (1·30 [1·29-1·31]), but the association with intracerebral haemorrhage was about twice as steep (1·68 [1·65-1·71]). HRs for vascular disease were twice as steep at ages 40-49 years than at ages 70-79 years. Usual systolic blood pressure was also positively associated with incident chronic kidney disease (1·40 [1·35-1·44]) and diabetes (1·14 [1·12-1·15]). About half of all vascular deaths in China were attributable to elevated blood pressure (ie, systolic blood pressure >120 mm Hg), accounting for approximately 1 million deaths (<80 years of age) annually. INTERPRETATION Among adults in China, systolic blood pressure was continuously related to major vascular disease with no evidence of a threshold down to 120 mm Hg. Unlike previous studies in high-income countries, blood pressure was more strongly associated with intracerebral haemorrhage than with ischaemic stroke. Even small reductions in mean blood pressure at a population level could be expected to have a major impact on vascular morbidity and mortality. FUNDING UK Wellcome Trust, UK Medical Research Council, British Heart Foundation, Cancer Research UK, Kadoorie Charitable Foundation, Chinese Ministry of Science and Technology, and the National Science Foundation of China.
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Affiliation(s)
- Ben Lacey
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
| | - Sarah Lewington
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK; Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Robert Clarke
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Xiang Ling Kong
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK; Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Yiping Chen
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK; Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Yu Guo
- Chinese Academy of Medical Sciences, Beijing, China
| | - Ling Yang
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK; Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Derrick Bennett
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Fiona Bragg
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Zheng Bian
- Chinese Academy of Medical Sciences, Beijing, China
| | - Shaojie Wang
- Qingdao Municipal Center for Disease Control and Prevention, Qingdao, China
| | - Hua Zhang
- Qingdao Municipal Center for Disease Control and Prevention, Qingdao, China
| | - Junshi Chen
- National Center for Food Safety Risk Assessment, Beijing, China
| | - Robin G Walters
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Rory Collins
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Richard Peto
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Liming Li
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China.
| | - Zhengming Chen
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Profile of Dr. Dongfeng Gu. SCIENCE CHINA. LIFE SCIENCES 2018; 61:501-503. [PMID: 29564600 DOI: 10.1007/s11427-018-9282-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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Han C, Liu F, Yang X, Chen J, Li J, Cao J, Li Y, Shen C, Yu L, Liu Z, Wu X, Zhao L, Hu D, Lu X, Wu X, Gu D. Ideal cardiovascular health and incidence of atherosclerotic cardiovascular disease among Chinese adults: the China-PAR project. SCIENCE CHINA-LIFE SCIENCES 2018; 61:504-514. [PMID: 29721777 DOI: 10.1007/s11427-018-9281-6] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 02/26/2018] [Indexed: 01/15/2023]
Abstract
Existing evidence on the relationship between cardiovascular health (CVH) metrics and cardiovascular disease (CVD) was primarily derived from western populations. We aimed to evaluate the benefits of ideal CVH metrics on preventing incident atherosclerotic CVD (ASCVD) in Chinese population. This study was conducted among 93,987 adults from the China-PAR project (Prediction for ASCVD Risk in China) who were followed up until 2015. Cox proportional hazard regression models were used to estimate the hazard ratios (HRs) and their corresponding 95% confidence intervals (CIs) of CVH metrics for the risk of ASCVD, including coronary heart disease (CHD), stroke and ASCVD death. We further estimated the population-attributable risk percentage (PAR%) of these metrics in relation to each outcome. We observed gradient inverse associations between the number of ideal CVH metrics and ASCVD incidence. Compared with participants having ≤2 ideal CVH metrics, the multivariable-adjusted HRs (95% CIs) of ASCVD for those with 3, 4, 5, 6 and 7 ideal CVH metrics were 0.83 (0.74-0.93), 0.66 (0.59-0.74), 0.55 (0.48-0.61), 0.44 (0.38-0.50) and 0.24 (0.18-0.31), respectively (P for trend <0.0001). Approximately 62.1% of total ASCVD, 38.7% of CHD, 66.4% of stroke, and 60.5% of ASCVD death were attributable to not achieving all the seven ideal CVH metrics. After adjusting effects of ideal health factors, having four ideal health behaviors could independently bring adults health benefits in preventing 17.4% of ASCVD, 18.0% of CHD, 16.7% of stroke, and 10.1% of ASCVD death. Among all the seven CVH metrics, to keep with ideal blood pressure (BP) implied the largest public health gains against various ASCVD events (PAR% between 33.0% and 47.2%), while ideal diet was the metric most difficult to be achieved in the long term. Our study indicates that the more ideal CVH metrics adults have, the less ASCVD burden there is in China. Special efforts of health education and behavior modification should be made on keeping ideal BP and dietary habits in general Chinese population to prevent the epidemic of ASCVD.
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Affiliation(s)
- Chao Han
- Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Fangchao Liu
- Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Xueli Yang
- Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Jichun Chen
- Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Jianxin Li
- Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Jie Cao
- Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Ying Li
- Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Chong Shen
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, 211166, China
| | - Ling Yu
- Department of Cardiology, Fujian Provincial People's Hospital, Fuzhou, 350004, China
| | - Zhendong Liu
- Cardio-Cerebrovascular Control and Research Center, Institute of Basic Medicine, Shandong Academy of Medical Sciences, Jinan, 250062, China
| | - Xianping Wu
- Sichuan Center for Disease Control and Prevention, Chengdu, 610041, China
| | - Liancheng Zhao
- Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Dongshen Hu
- Department of Prevention Medicine, Shenzhen University School of Medicine, Shenzhen, 518060, China
| | - Xiangfeng Lu
- Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Xigui Wu
- Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Dongfeng Gu
- Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China.
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The burden, management rates and influencing factors of high blood pressure in a Chinese rural population: the Rural Diabetes, Obesity and Lifestyle (RuralDiab) study. J Hum Hypertens 2018; 32:236-246. [PMID: 29440701 DOI: 10.1038/s41371-018-0039-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 01/03/2018] [Accepted: 01/29/2018] [Indexed: 01/26/2023]
Abstract
The aim of the present study was to examine the prevalence, awareness, treatment, control, and potentially influencing factors of high blood pressure (HBP) in Chinese rural adults based on a cross-sectional study. Using data from the Rural Diabetes, Obesity and Lifestyle (RuralDiab) study, a total of 30,834 participants aged 18-74 years were enrolled for the epidemiological study. The multivariate logistic regression model including all selected potentially influencing factors was carried out for the adjusted odds ratios (ORs) and 95% confidence intervals (CIs). Overall, a total of 9872 individuals were diagnosed as HBP (32.02%) with substantial imparity between men and women (32.87% vs. 30.58%), and the corresponding age-standardized prevalence of HBP were 19.50% (20.94% in men and 18.85% in women). Among the HBP patients, 6654 were aware of the diagnosis (67.40%), 5391 were taking medication (54.61%), and 2572 had their blood pressure controlled (26.05%).The corresponding age-adjusted awareness, treatment, and control of HBP were 59.35%, 45.91%, and 23.87%, respectively, and the corresponding rates were higher in women than those in men. The age-specific prevalence and management rates of HBP displayed increased trends with aging in both sexes(P trend < 0.05). Aging, low level of education, unhealthy lifestyle, positive family history of hypertension, overweight, obesity, diabetes, and dyslipidemia were associated with the prevalence, awareness, treatment, and control of HBP. In conclusion, uncontrolled HBP was common with high prevalence in Chinese rural residents. Strengthening the primary prevention through lifestyle modifications is necessary for reducing the disease burden and improving the management rates of HBP.
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Chanchai R, Kanjanavanit R, Leemasawat K, Amarittakomol A, Topaiboon P, Phrommintikul A. Clinical tolerability of generic versus brand beta blockers in heart failure with reduced left ventricular ejection fraction: a retrospective cohort from heart failure clinic. J Drug Assess 2018; 7:8-13. [PMID: 29379674 PMCID: PMC5769774 DOI: 10.1080/21556660.2018.1423988] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 12/23/2017] [Indexed: 12/21/2022] Open
Abstract
Background: Beta-blockers have been shown to decrease mortality and morbidity in heart failure with reduced ejection fraction (HFrEF) patients. However, the side effects are also dose-related, leading to the underdosing. Cost constraint may be one of the limitations of appropriate beta-blocker use; this can be improved with generic drugs. However, the effects in real life practice have not been investigated. Methods and results: This study aimed to compare the efficacy and safety of generic and brand beta-blockers in HFrEF patients. We performed a retrospective cohort analysis in HFrEF patients who received either generic or brand beta-blocker in Chiang Mai Heart Failure Clinic. The primary endpoint was the proportion of patients who received at least 50% target dose of beta-blocker between generic and brand beta-blockers. Adverse events were secondary endpoints. 217 patients (119 and 98 patients received generic and brand beta-blocker, respectively) were enrolled. There were no differences between groups regarding age, gender, etiology of heart failure, New York Heart Association (NYHA) functional class, left ventricular ejection fraction (LVEF), rate of receiving angiotensin converting enzyme inhibitor (ACEI), angiotensin recepter blocker (ARB), or spironolactone. Patients receiving brand beta-blockers had lower resting heart rate at baseline (74.9 and 84.2 bpm, p = .001). Rate of achieved 50% target dose and target daily dose did not differ between groups (40.4 versus 44.5% and 48.0 versus 55.0%, p > .05, respectively). Rate of side effects was not different between groups (32.3 versus 29.5%, p > .05) and the most common side effect was hypotension. Conclusion: This study demonstrated that beta-blocker tolerability was comparable between brand and generic formulations. Generic or brand beta-blockers should be prescribed to HFrEF patients who have no contraindications.
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Affiliation(s)
- Rattanachai Chanchai
- Northern Cardiac Center, Faculty of Medicine, Chiang Mai UniversityChiang MaiThailand
| | - Rungsrit Kanjanavanit
- Northern Cardiac Center, Faculty of Medicine, Chiang Mai UniversityChiang MaiThailand.,Department of Internal Medicine, Faculty of Medicine, Chiang Mai UniversityChiang MaiThailand
| | - Krit Leemasawat
- Northern Cardiac Center, Faculty of Medicine, Chiang Mai UniversityChiang MaiThailand
| | - Anong Amarittakomol
- Northern Cardiac Center, Faculty of Medicine, Chiang Mai UniversityChiang MaiThailand
| | - Paleerat Topaiboon
- Northern Cardiac Center, Faculty of Medicine, Chiang Mai UniversityChiang MaiThailand
| | - Arintaya Phrommintikul
- Northern Cardiac Center, Faculty of Medicine, Chiang Mai UniversityChiang MaiThailand.,Department of Internal Medicine, Faculty of Medicine, Chiang Mai UniversityChiang MaiThailand
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Abstract
BACKGROUND With rapid economic development, urbanization, and an aging population, cardiovascular diseases (CVDs) have become the leading cause of death in China. OBJECTIVES The aim of this study was to provide a comprehensive review on the prevalence, awareness, treatment, and control of hypertension (HTN) as well as blood pressure (BP)-related morbidity and mortality of CVD in Chinese adults over time. FINDINGS The prevalence of HTN in China is high and increasing. Recent estimates are variable but indicate 33.6% (35.3% in men and 32% in women) or 335.8 million (178.6 million men and 157.2 million women) of the Chinese adult population had HTN in 2010, which represents a significant increase from previous surveys. BP-related CVD remains the leading cause of death in Chinese adults, with stroke being the predominant cause of cardiovascular deaths. Of those with HTN, 33.4% (30.4% in men and 36.7% in women) were aware of their condition, 23.9% (20.6% in men and 27.7% in women) were treated, and only 3.9% (3.5% in men and 4.3% in women) were controlled to the currently recommended target of BP <140/90 mm Hg. Awareness and treatment of HTN have improved over time, but HTN control has not. Geographic differences in the prevalence, awareness, treatment, and control of HTN are evident, both in terms of a north-south gradient and urban-rural disparity. CONCLUSIONS The prevalence of HTN is high and increasing, while the control rate is low in Chinese adults. Combatting HTN and BP-related morbidity and mortality will require a comprehensive approach at national and local levels. The major challenge moving forward is to develop and implement effective, practical, and sustainable prevention and treatment strategies in China.
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Affiliation(s)
- Joshua D Bundy
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA
| | - Jiang He
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA.
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Zhang D, Wang G, Joo H. A Systematic Review of Economic Evidence on Community Hypertension Interventions. Am J Prev Med 2017; 53:S121-S130. [PMID: 29153113 PMCID: PMC5819001 DOI: 10.1016/j.amepre.2017.05.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 04/24/2017] [Accepted: 05/08/2017] [Indexed: 01/05/2023]
Abstract
CONTEXT Effective community-based interventions are available to control hypertension. It is important to determine the economics of these interventions. EVIDENCE ACQUISITION Peer-reviewed studies from January 1995 through December 2015 were screened. Interventions were categorized into educational interventions, self-monitoring interventions, and screening interventions. Incremental cost-effectiveness ratios were summarized by types of interventions. The review was conducted in 2016. EVIDENCE SYNTHESIS Thirty-four articles were included in the review (16 from the U.S., 18 from other countries), including 25 on educational interventions, three on self-monitoring interventions, and six on screening interventions. In the U.S., five (31.3%) studies on educational interventions were cost saving. Among the studies that found the interventions cost effective, the median incremental costs were $62 (range, $40-$114) for 1-mmHg reduction in systolic blood pressure (SBP) and $13,986 (range, $6,683-$58,610) for 1 life-year gained. Outside the U.S., educational interventions cost from $0.62 (China) to $29 (Pakistan) for 1-mmHg reduction in SBP. Self-monitoring interventions, evaluated in the U.S. only, cost $727 for 1-mmHg reduction in SBP and $41,927 for 1 life-year gained. For 1 quality-adjusted life-year, screening interventions cost from $21,734 to $56,750 in the U.S., $613 to $5,637 in Australia, and $7,000 to $18,000 in China. Intervention costs to reduce 1 mmHg blood pressure or 1 quality-adjusted life-year were higher in the U.S. than in other countries. CONCLUSIONS Most studies found that the three types of interventions were either cost effective or cost saving. Quality of economic studies should be improved to confirm the findings.
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Affiliation(s)
- Donglan Zhang
- Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, Georgia.
| | - Guijing Wang
- Division for Heart Disease and Stroke Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Heesoo Joo
- Division of Global Migration and Quarantine, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
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Dainelli L, Xu T, Li M, Zimmermann D, Fang H, Wu Y, Detzel P. Cost-effectiveness of milk powder fortified with potassium to decrease blood pressure and prevent cardiovascular events among the adult population in China: a Markov model. BMJ Open 2017; 7:e017136. [PMID: 28951410 PMCID: PMC5623478 DOI: 10.1136/bmjopen-2017-017136] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE To model the long-term cost-effectiveness of consuming milk powder fortified with potassium to decrease systolic blood pressure (SBP) and prevent cardiovascular events. DESIGN A best case scenario analysis using a Markov model was conducted. PARTICIPANTS 8.67% of 50-79 year olds who regularly consume milk in China, including individuals with and without a prior diagnosis of hypertension. INTERVENTION The model simulated the potential impact of a daily intake of two servings of milk powder fortified with potassium (+700 mg/day) vs the consumption of a milk powder without potassium fortification, assuming a market price equal to 0.99 international dollars (intl$; the consumption of a milk powder without potassium fortification, assuming a market price equal to intl$0.99 for the latter and to intl$1.12 for the first (+13.13%). Both deterministic and probabilistic sensitivity analyses were conducted to test the robustness of the results. MAIN OUTCOME MEASURES Estimates of the incidence of cardiovascular events and subsequent mortality in China were derived from the literature as well as the effect of increasing potassium intake on blood pressure. The incremental cost-effectiveness ratio (ICER) was used to determine the cost-effectiveness of a milk powder fortified with potassium taking into consideration the direct medical costs associated with the cardiovascular events, loss of working days and health utilities impact. RESULTS With an ICER equal to int$4711.56 per QALY (quality-adjusted life year) in the best case scenario and assuming 100% compliance, the daily consumption of a milk powder fortified with potassium shown to be a cost-effective approach to decrease SBP and reduce cardiovascular events in China. Healthcare savings due to prevention would amount to intl$8.41 billion. Sensitivity analyses showed the robustness of the results. CONCLUSION Together with other preventive interventions, the consumption of a milk powder fortified with potassium could represent a cost-effective strategy to attenuate the rapid rise in cardiovascular burden among the 50-79 year olds who regularly consume milk in China.
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Affiliation(s)
| | - Tingting Xu
- China Center for Health Development Studies, Peking University, Beijing, China
- Department of Health Policy and Administration, Peking University School of Public Health, Beijing, China
| | - Min Li
- Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing, China
| | | | - Hai Fang
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Yangfeng Wu
- Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing, China
- The George Institute for Global Health, Peking University Health Science Centre, Beijing, China
- Peking University Clinical Research Institute, Beijing, China
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