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Levy P, Lemański T, Crossan C, Lefebvre A, Brière JB, Degli Esposti L, Khan ZM. Cost-effectiveness analysis comparing single-pill combination of perindopril/amlodipine/indapamide to the free equivalent combination in patients with hypertension from an Italian national health system perspective. Expert Rev Pharmacoecon Outcomes Res 2024:1-9. [PMID: 38848115 DOI: 10.1080/14737167.2024.2365988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 05/07/2024] [Indexed: 06/15/2024]
Abstract
OBJECTIVE To evaluate the cost-effectiveness of a single-pill combination (SPC) of perindopril/amlodipine/indapamide versus its free equivalent combination (FEC) in adults with hypertension in Italy. METHODS A Markov model was developed to perform a cost-utility analysis with a lifetime horizon and an Italian healthcare payer's perspective. In the model, the additional effect of the SPC on blood pressure level compared with the FEC was translated into a decreased risk of cardiovascular events and CKD, which was modeled via Framingham risk algorithms. Difference in persistence rates of SPC and FEC were modeled via discontinuation rates. RESULTS A perindopril/amlodipine/indapamide SPC is associated with lower cost and better health outcomes compared to its FEC. Over a lifetime horizon, it is associated with a 0.050 QALY gain and cost savings of €376, resulting from lower cardiovascular event rates. In the alternative scenario, where different approach for modeling impact of adherence was considered, incremental gain of 0.069 QALY and savings of €1,004 were observed. Results were robust to sensitivity and scenario analyses, indicating that use of this SPC is a cost-effective strategy. CONCLUSIONS The findings indicate that a perindopril/amlodipine/indapamide SPC is a cost-saving treatment option for hypertension in Italy, compared to its FEC.
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Affiliation(s)
- Pierre Levy
- Université Paris-Dauphine, Université PSL, LEDA, [LEGOS], Paris, France
| | | | | | - Anna Lefebvre
- Global Value & Access and Pricing, Servier Group, Suresnes, France
| | | | - Luca Degli Esposti
- CliCon S.r.l. Società Benefit, Health, Economics and Outcomes Research, Bologna, Italy
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Reference data among general population and known-groups validity among hypertensive population of the EQ-5D-5L in Vietnam. Qual Life Res 2021; 31:539-550. [PMID: 34370187 PMCID: PMC8847252 DOI: 10.1007/s11136-021-02959-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2021] [Indexed: 12/02/2022]
Abstract
Purpose This study aims to provide EQ-5D-5L population norms among the general population in Vietnam and to test EQ-5D-5L’ construction validity among people living with hypertension there. Methods Descriptive statistics of the five dimensions and five levels, EQ-VAS and EQ-5D-5L indexes were categorised into gender and age groups for the EQ-5D-5L population norms. Known-groups testing was set for lower EQ-5D-5L outcomes among people who were aware of their hypertensive status, females, people with more comorbidities, less education, older ages, and higher body mass indexes. Level of confident interval was 95%. Results The mean EQ-VAS and EQ-5D-5L indexes were 81.10 (SD: 13.35) and 0.94 (SD: 0.09) among the general population. The EQ-5D-5L outcomes were better among younger people, males, people with more education, employees, and single people. Respondents reported fewer problems with self-care and usual activities and tend to have problems at higher levels across older ages. The known-group testing showed statistically significant results. The mean EQ-VAS and EQ-5D-5L indexes of people in the diagnosed hypertensive group (71.48 and 0.94, respectively) were statistically significantly smaller than they were in the non-hypertensive and undiagnosed hypertensive group (76.65 and 0.97; 76.95 and 0.96 accordingly). Statistically significant associations of lower EQ-5D-5L indexes and EQ-VAS were found among people diagnosed for hypertension, people suffering from an incremental comorbidity, and obese people. Conclusion This study has provided EQ-5D-5L population norms for the general population and evidence for known-groups validity of the EQ-5D-5L instrument among hypertensive people in Vietnam. Supplementary Information The online version contains supplementary material available at 10.1007/s11136-021-02959-2.
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Taylor C, Hoek AC, Deltetto I, Peacock A, Ha DTP, Sieburg M, Hoang D, Trieu K, Cobb LK, Jan S, Webster J. The cost-effectiveness of government actions to reduce sodium intake through salt substitutes in Vietnam. ACTA ACUST UNITED AC 2021; 79:32. [PMID: 33706807 PMCID: PMC7953693 DOI: 10.1186/s13690-021-00540-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 02/07/2021] [Indexed: 11/29/2022]
Abstract
Background Dietary sodium reduction is recommended to reduce the burden of cardiovascular disease. In Vietnam food products including salt, fish sauce and bot canh contribute to ~ 70% of dietary sodium intake. Reduced sodium versions of these products can be produced by replacing some of the sodium chloride with potassium chloride. We aimed to assess the cost-effectiveness of three alternative approaches to introducing reduced sodium products onto the market with a view to lowering population sodium intake in Vietnam. Methods The three salt substitution strategies included voluntary, subsidised and regulatory approaches targeting salt, fish sauce and bot canh products. Costs were modelled using the WHO-CHOICE methodology. A Markov cohort model was developed to evaluate the cost-effectiveness of each strategy versus no intervention from the government perspective. The model linked each intervention strategy to assumed changes in levels of sodium intake and then to systolic blood pressure. Changes in SBP were linked to a probability of ischaemic heart disease or stroke. The model followed people over their lifetime to assess average costs and quality adjusted life years (QALYs) gained for each strategy. Results The voluntary salt substitution strategy was assumed to require no investment by government. Following ramp up (years 6+), the average annual costs for the subsidised and regulatory strategies were 21,808,968,902 ₫ (US$ 977,354) and 12,949,953,247 ₫ (US$ 580,410) respectively. Relative to no intervention, all three salt substitution strategies were found to be cost-effective. Cost savings were driven by reductions in strokes (32,595; 768,384; 2,366,480) and ischaemic heart disease (IHD) events (22,830; 537,157; 1,648,590) for the voluntary, subsidised & regulatory strategies, respectively. The voluntary strategy was least cost-effective (− 3445 ₫ US$ -0.15; 0.009 QALYs gained) followed by the subsidised strategy (− 43,189 ₫ US$ -1.86; 0.022 QALYs gained) and the regulatory strategy delivered the highest cost savings and health gains (− 243,530 ₫ US$ -10.49; 0.074 QALYs gained). Conclusion This research shows that all three modelled salt substitution strategies would be good value for money relative to no intervention in Vietnam. The subsidised alternative would require the highest level of government investment; however the implementation costs will be exceeded by healthcare savings assuming a reasonable time horizon is considered. Supplementary Information The online version contains supplementary material available at 10.1186/s13690-021-00540-4.
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Affiliation(s)
- Colman Taylor
- The George Institute for Global Health, Australia University of NSW, PO Box M201, Missenden Rd, Camperdown, NSW, 2050, Australia. .,Health Technology Analysts Pty Ltd, Surry Hills, Australia.
| | - Annet C Hoek
- The George Institute for Global Health, Australia University of NSW, PO Box M201, Missenden Rd, Camperdown, NSW, 2050, Australia
| | - Irene Deltetto
- Health Technology Analysts Pty Ltd, Surry Hills, Australia
| | - Adrian Peacock
- Health Technology Analysts Pty Ltd, Surry Hills, Australia
| | | | | | | | - Kathy Trieu
- The George Institute for Global Health, Australia University of NSW, PO Box M201, Missenden Rd, Camperdown, NSW, 2050, Australia
| | - Laura K Cobb
- Resolve to Save Lives, An Initiative of Vital Strategies, New York, NY, USA
| | - Stephen Jan
- The George Institute for Global Health, Australia University of NSW, PO Box M201, Missenden Rd, Camperdown, NSW, 2050, Australia
| | - Jacqui Webster
- The George Institute for Global Health, Australia University of NSW, PO Box M201, Missenden Rd, Camperdown, NSW, 2050, Australia
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Liu X, Bai G, Li H, Li S. Applying SF-6D to measure health state utilities among the middle and old aged patients with hypertension in China. Health Qual Life Outcomes 2020; 18:385. [PMID: 33308242 PMCID: PMC7731619 DOI: 10.1186/s12955-020-01598-4] [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: 07/02/2020] [Accepted: 10/07/2020] [Indexed: 01/10/2023] Open
Abstract
Purpose Hypertension is a growing public health problem in China; however, little is known about health-related quality of life (HRQoL) especially health state utility (HSU) of patients with hypertension in rural China. This study aimed to examine the HSU as measured by SF-6D and to investigate its associated factors among middle and old aged patients with hypertension in rural China. Methods Data were collected from twelve villages in Shandong Province in 2016. SF-36 was administrated to measure HRQoL of middle and old aged patients with hypertension and was got to the SF-6D values using Hong Kong’s tariff. Descriptive analyses, such as demographic characteristics, socio-economic status, and utility, were stratified by hypertension classification. Multiple linear regression models were applied to assess the associated factors of HSU. Results A total of 933 (response rate:86.4%) middle and old aged patients (69.1 ± 8.2 years) with hypertension participated in the study. 39.4% of participants were male; 44.2% had stage I hypertension; 26.4% had stage II and above. The mean score of SF-6D utility score was 0.743 (SD: 0.14, range: 0.32–1.00, median: 0.756, Interquartile range:0.634–0.859). Being female (β = −0.046), having two or more comorbidities (2 vs. 1 β = −0.066; > 3 vs. 1 β = −0.098) and the health expenditure higher than 2000 RMB (2000–3999 vs.< 2000 β = −0.042; 4000–5999 vs. < 2000 β = −0.046; > 6000 vs. < 2000 β = −0.071) were significantly associated with lower SF-6D overall score; while being farmer (β = 0.032), having high household income (10,000–14,999 vs. < 5000 β = 0.045; > 15,000 vs. < 5000 β = 0.064) and having stage I and above hypertension (stage I vs. Normotensive β = 0.047; stage II vs. Normotensive β = 0.079; stage III vs. Normotensive β = 0.095) were significantly associated with higher SF-6D overall score. Conclusion SF-6D was capable to measure quality of life middle and old aged patients with hypertension in China. And multiple factors were demonstrated to be significantly associated with quality of life.
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Affiliation(s)
- Xiaohan Liu
- Centre for Health Management and Policy Research, School of Health Care Management, Cheeloo College of Medicine, Shandong University, Wenhua Xi Rd 44, Jinan, 250012, Shandong Province, People's Republic of China.,NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, 250012, People's Republic of China
| | - Guannan Bai
- Department of Public Health, Erasmus MC-University Medical Center, Wytemaweg 80, Rotterdam, 3015CN, The Netherlands
| | - Hui Li
- Centre for Health Management and Policy Research, School of Health Care Management, Cheeloo College of Medicine, Shandong University, Wenhua Xi Rd 44, Jinan, 250012, Shandong Province, People's Republic of China. .,NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, 250012, People's Republic of China.
| | - Shunping Li
- Centre for Health Management and Policy Research, School of Health Care Management, Cheeloo College of Medicine, Shandong University, Wenhua Xi Rd 44, Jinan, 250012, Shandong Province, People's Republic of China. .,NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, 250012, People's Republic of China. .,Centre for Quality of Life and Public Policy Research, Shandong University, Jinan, 250012, People's Republic of China.
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Meiqari L, Nguyen TPL, Essink D, Zweekhorst M, Wright P, Scheele F. Access to hypertension care and services in primary health-care settings in Vietnam: a systematic narrative review of existing literature. Glob Health Action 2019; 12:1610253. [PMID: 31120345 PMCID: PMC6534204 DOI: 10.1080/16549716.2019.1610253] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 04/15/2019] [Indexed: 02/05/2023] Open
Abstract
Background: Health care in Vietnam is challenged by a high burden of hypertension (HTN). Since 2000, several interventions were implemented to manage HTN; it is not clear what is the status of patient access to HTN care. Objective: This article aims to perform a systematic narrative review of the available evidence on access to HTN care and services in primary health-care settings in Vietnam. Methods: Search engines were used to identify relevant records of scientific and grey literature. Data from selected articles were analysed using standardised spreadsheets and MaxQDA and following a framework synthesis methodology. Results: There has been increasing interest in research and policy concerning the burden of HTN in Vietnam, covering many aspects of access to treatment at the primary health-care level. Vietnam's National HTN Programme is managed as a vertical programme and its services integrated into the network of primary health-care facilities across the public sector in selected provinces. The Programme financed population-wide screening campaigns for the early detection of HTN among people above 40 years of age. There was no information on the acceptability of HTN health services, especially regarding the interaction between patients and health professionals. In general, articles reported good availability of medication, but problems in accessing them included: fragmentation and lack of consistency in prescribing medication between different levels and short timespans for dispensing medication at primary health-care facilities. There was limited information related to the cost and economic impact of HTN treatment. Treatment adherence among hypertensive patients based on four studies did not exceed 70%. Conclusions: Although the Vietnamese health-care system has taken steps to accommodate some of the needs of HTN patients, it is crucial to scale-up interventions that allow for regular, systematic, and integrated care, especially at the lowest levels of care.
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Affiliation(s)
- Lana Meiqari
- Athena Institute for Research on Innovation and Communication in Health and Life Sciences, Faculty of Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Thi-Phuong-Lan Nguyen
- Department of Social Medicine, Faculty of Public Health, Thai Nguyen University of Medicine and Pharmacy, Thai Nguyen, Vietnam
| | - Dirk Essink
- Athena Institute for Research on Innovation and Communication in Health and Life Sciences, Faculty of Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Marjolein Zweekhorst
- Athena Institute for Research on Innovation and Communication in Health and Life Sciences, Faculty of Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Pamela Wright
- Guelph International Health Consulting, Amsterdam, The Netherlands
| | - Fedde Scheele
- Athena Institute for Research on Innovation and Communication in Health and Life Sciences, Faculty of Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Nguyen TPL, Wright EP, Nguyen TT, Schuiling-Veninga CCM, Bijlsma MJ, Nguyen TBY, Postma MJ. Cost-Effectiveness Analysis of Screening for and Managing Identified Hypertension for Cardiovascular Disease Prevention in Vietnam. PLoS One 2016; 11:e0155699. [PMID: 27192051 PMCID: PMC4871542 DOI: 10.1371/journal.pone.0155699] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 05/03/2016] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To inform development of guidelines for hypertension management in Vietnam, we evaluated the cost-effectiveness of different strategies on screening for hypertension in preventing cardiovascular disease (CVD). METHODS A decision tree was combined with a Markov model to measure incremental cost-effectiveness of different approaches to hypertension screening. Values used as input parameters for the model were taken from different sources. Various screening intervals (one-off, annually, biannually) and starting ages to screen (35, 45 or 55 years) and coverage of treatment were analysed. We ran both a ten-year and a lifetime horizon. Input parameters for the models were extracted from local and regional data. Probabilistic sensitivity analysis was used to evaluate parameter uncertainty. A threshold of three times GDP per capita was applied. RESULTS Cost per quality adjusted life year (QALY) gained varied in different screening scenarios. In a ten-year horizon, the cost-effectiveness of screening for hypertension ranged from cost saving to Int$ 758,695 per QALY gained. For screening of men starting at 55 years, all screening scenarios gave a high probability of being cost-effective. For screening of females starting at 55 years, the probability of favourable cost-effectiveness was 90% with one-off screening. In a lifetime horizon, cost per QALY gained was lower than the threshold of Int$ 15,883 in all screening scenarios among males. Similar results were found in females when starting screening at 55 years. Starting screening in females at 45 years had a high probability of being cost-effective if screening biannually was combined with increasing coverage of treatment by 20% or even if sole biannual screening was considered. CONCLUSION From a health economic perspective, integrating screening for hypertension into routine medical examination and related coverage by health insurance could be recommended. Screening for hypertension has a high probability of being cost-effective in preventing CVD. An adequate screening strategy can best be selected based on age, sex and screening interval.
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Affiliation(s)
- Thi-Phuong-Lan Nguyen
- University of Groningen, Department of Pharmacy, Unit of PharmacoEpidemiology & PharmacoEconomics, Groningen, the Netherlands
| | - E. Pamela Wright
- Medical Committee Netherlands-Vietnam, Amsterdam, The Netherlands
| | | | - C. C. M. Schuiling-Veninga
- University of Groningen, Department of Pharmacy, Unit of PharmacoEpidemiology & PharmacoEconomics, Groningen, the Netherlands
| | - M. J. Bijlsma
- University of Groningen, Department of Pharmacy, Unit of PharmacoEpidemiology & PharmacoEconomics, Groningen, the Netherlands
| | - Thi-Bach-Yen Nguyen
- Department of Health economic, Ha Noi University of Medicine, Ha Noi, Vietnam
| | - M. J. Postma
- University of Groningen, Department of Pharmacy, Unit of PharmacoEpidemiology & PharmacoEconomics, Groningen, the Netherlands
- Institute for Science in Healthy Aging & healthcaRE (SHARE), University Medical Center Groningen (UMCG), Groningen, The Netherland
- Department of Epidemiology, UMCG, Groningen, The Netherlands
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