高血压社区规范化管理中常用抗高血压药物的成本-效果研究

摘要

目的 评价高血压社区规范化管理中5大类常用抗高血压药物的成本-效果. 方法 基于行政区域分布和经济发展水平, 在我国东、 中、 西部选择15个省/自治区的220家社区卫生服务中心/站和卫生院, 利用 《中国高血压防治指南 (2009年基层版)》 中高血压社区规范化管理方案对卫生机构医务人员进行培训, 由受训的基层医务人员对高血压患者实施规范化管理1年. 资料齐全且规范化管理满1年的患者共43 039例, 在接受高血压单药治疗且随访期间治疗方案不变 (但允许药物剂量调整) 的10 456例患者中, 有10 277例服用利尿剂、 钙拮抗剂、 β-受体阻滞剂、 血管紧张素Ⅱ受体拮抗剂 (ARB) 及血管紧张素转化酶抑制剂 (ACEI) 5大类抗高血压药物, 根据性别、 年龄和危险分层分组, 按照1:6:1:1:3的比例进行匹配, 最后入选7 032例患者作为本研究对象. 受训者填写统一设计的管理病历, 记录患者的社会人口学特征、 合并症、 高血压分级和危险分层以及抗高血压药物的日用药剂量、 规格、 价格、实际服用天数等药物治疗信息. 采用成本-效果分析法评价抗高血压药物的成本 -效果. 结果 7 032例进行成本-效果分析的患者中, 年人均成本为219.0 (553.0) 元; 收缩压下降率为 (10.6 ±8.6)%, 成本-效果比为20.7; 舒张压下降率为 (10.0 ±9.6)%, 成本-效果比为21.9; 血压控制率为75.1% (5 281/7 032), 成本-效果比为2.9. 5大类抗高血压药物的年人均成本比较, 差异有统计学意义 ( P<0.05 ). 5大类抗高血压药物的收缩压下降率、 舒张压下降率、 血压控制率比较, 差异均有统计学意义 ( P<0.05 ). 以收缩压下降率、 舒张压下降率、 血压控制率为效果指标时, ACEI的成本-效果比分别为5.0、 5.3、 0.9, 利尿剂的成本-效果比分别为19.0、 18.6、 2.5, 均较β-受体阻滞剂、 钙拮抗剂、 ARB的成本-效果比低. 结论 在高血压社区规范化管理中, ACEI和利尿剂具有更好的成本-效果.%Objective To evaluate the cost -effectiveness of five common antihypertensive drugs in community standardized management of hypertension .Methods According to administrative regional distribution and economic development level, 220 community health service centers (stations) and township health centers from 15 provinces/autonomous regions in the east, middle and west regions in China were selected .Using the community standardized hypertension management plan in China Guideline for Hypertension Prevention and Control (2009 grassroot version), we conducted training on the health workers in these included medical settings , and the trainees were required to undertaken one -year standardized management on hypertensive patients.There were all together 43 039 patients who had complete data and received standardized management for more than 1 year, and 10 456 patients were treated with monotherapy on hypertension and didn′t change therapeutic regimen during follow up period ( dosage adjustment was allowed ) .There were 10 277 patients who were administrated with five major antihypertensive drugs, including diuretic , calcium antagnists , β-receptor blocker , angiotensin Ⅱreceptor antagonists ( ARB ) and angiotensin converting enzyme inhibitor ( ACEI) .According to gender , age, and risk stratification and a match ratio of 1:6:1:1:3, a total of 7 032 patients were included as study subjects .The trained health workers filled out uniform medical records , and we recorded sociodemographic characteristics , complications, hypertension grade, risk grade and the daily dosage , scale, price and actual number of days of drug administration .Cost -effectiveness analytical method was used to evaluate the cost -effectiveness of antihypertensive drug .Results Among 7 032 patients included in the cost -effectiveness analysis , the annual cost per person was 219.0 (553.0) yuan, the drop rate of systolic pressure was (10.6 ±8.6)%, and the cost -effectiveness ratio was 20.7; the drop rate of diastolic pressure was (10.0 ±9.6)%, cost-effectiveness ratio was 21.9; the control rate of blood pressure was 75.1% (5 281/7 032), cost-effectiveness ratio was 2.9.There were significant differences among the five antihypertensive drugs in annual cost per person (P<0.05) .The five major antihypertensive drugs were significantly different in the drop rate of systolic pressure , the drop rate of diastolic pressure and the control rate of blood pressure ( P<0.05 ) .When taking the drop rate of systolic pressure , the drop rate of diastolic pressure and the control rate of blood pressure as effectiveness indexes, the cost-effectiveness ratios of ACEI were 5.0, 5.3 and 0.9 and the cost-effectiveness ratios of diuretic were 19.0, 18.6 and 2.5, both lower than those of β-receptor blocker, calcium antagnists and ARB.Conclusion In community standardized management of hypertension , ACEI and diuretic have better cost -effectiveness than other drugs .