The Economic Evaluation Of The Health Intervention Effectiveness On The Prehypertension Based On The Community

Due to the high prevalence and the burden of the Hypertensive disease,and the current situation of prevention and control of hypertension,more attention should be paid on the hazards of elevated blood pressure,and then the Prehypertension is a research point and should be strengthed consideration.The Prehypertensive phenomenon is a range of blood pressure before clinical hypertension.It is a situation of suffering of hypertension,not only as the cause of hypertension,also could be used as a biomarker of high blood pressure.Many studies have shown that the hypertension and Prehypertension have the co-risk factors.A cohort study of cardiovascular disease suggests that there would be double risk of ischemic heart disease and stroke,when the systolic blood pressure increased 20 mmHg from 115 mmHg,or diastolic blood pressure increased 10 mmHg from 75 mmHg.Studies have also shown that people with pre-hypertension have a higher risk of cardiovascular disease than those with normal blood pressure.Since being presented,the Prehypertension are attached more and more important to.Objective:Our study is based on essential public health services,according to the highly incidence of the Prehypertension,and aggregation of multi-risk factors,a design was proposed to conduct a baseline surveys to screen out the pre-hypertension population in the community,then sampled to different group randomly,conduct a four-year intervention cohort.In order to provide valid evidence of the intervention of the Prehypertension,the effect of the short-term interventions was illustrated by repeated measure analysis and other statistical tests,and also the published literature,the annual report of health statistics and the results of meta-analysis were used,and a Markov model was applied to figure out the mid-and long-term cost effects and benefit analysis of the pre-hypertension intervention program.Methods:The Prehypertension were selected out from different districts and counties,in Jiangsu Province.According to the inclusion and exclusion criteria of the Prehypertension,three intervention groups were set up in urban(Liangxi District,Wuxi City)and rural(Sheyang County,Yancheng City)with 575 people in the intervention group,corresponding set 3 control groups,about 700 people.Group management and individualized health educations were carried out and lasted for 4 years.A final assessment and Markov model was used to simulate the input-output model of health intervention.Results:The baseline results showed that the prevalence of pre-hypertension in Jiangsu Province was higher,and the prevalence is higher in urban areas than rural areas,and higher in male than female,over 40 years old is a high incidence stage of the Prehypertension.The mainly risk factors ofthe Prehypertension are male,older age,overweight and obesity(and/or central obesity),family history of hypertension,and so on.Multiple risk factors are aggregated.The higer prevalence of the Prehypertension,with the growing age.And the Meditation can improve diastolic blood pressure,the diet can affect waist circumference and blood pressure was also been found.It is suggested that based on the screening,relying on essential public health services and taking the streets and townships as the unit.We should carry out community intervention experiments on variable risk factors to demonstrate the effect of health intervention.After four years of health management and follow-up practice,the outcome of the Prehypertension is different in intervention group and control group,the rate of transform to normal blood pressure is higher in intervention group,while the rate of transform to the hypertension is higher in control group.Meanwhile,the intervention effect of exercise volume,waist circumference and BMI was better than that of the control group were also observed.With the prolongation of intervention time,the intervention effect was more significant,and the goal of the project design was achieved.All the results showed that group intervention project has achieved significantly effectiveness,and the health management and follow-up intervention of the Prehypertension is feasible.The short-term cost and the long-term cost of the Prehypertension intervention,analyzed by Markov model,have the great advantages than the intervention cost and daily management cost of the hypertensive patients.By comparing the input and output of the two strategies of the health intervention,it was found that about 36659038.81? was more input in the intervention program,but the incidence of cardiovascular and cerebrovascular complications were reduced,and more medical expenses were saved.The per capita intervention cost of pre-hypertension was 518.36?,which was lower than the annual disease economic burden,and also lower than the cost of drug control of hypertension.According to the principle that the greater the ICER,the more cost-saving the medical treatment,the results were superior to the ICER intervention of cardiovascular risk factors.The incremental cost-effectiveness ratio(ICER)was 4767.73,1980.29,5636.38 for reducing a hypertensive patient,transform to normal blood pressure,and prevent to be CVD,respectively.And the ICER of other hypertensive complications such as CHD and ESRD were also the same phenomenon.The results of cost utility analysis show that there were about 3.29 QALYs difference between the two different groups,and the utility is 29.26(intervention group)and 25.97(control group).The average cost-effectiveness ratio of intervention was 1654.32/QALY lower than 2087.59/QALY of non-intervention group,and the total investment of intervention group is far less than that of non intervention group.The incremental cost-effectiveness ratio is 1765.92/QALY,which is better than the effect of drug control the blood pressure in the Prehypertensive population,and also superior to the cost utility result of clinical drug control on the hypertension.Therefore,it is feasible to carry out the prehypertension intervention program.According to the results of the cost benefit analysis,it is found that the net benefit of pre-hypertension intervention is much greater than the cost input,and is superior to the benefit of different drugs to control hypertension.The cost-benefit ratio of hypertension,CVD,CHD and ESRD,were 227.93,160.57,47.93 and 34.27 respectively.Comparing to the benefit cost ratio of the project of treatment the cardiovascular and cerebrovascular disease,the net benefit and benefitcost ratio of pre-hypertension intervention is much greater than that of control the high blood pressure.And the results of Markov model showed it had long-term social value for intervention in the pre-hypertension base on the community.Conclusions:After analyzing the danger of high blood pressure,and the controllable characteristics of blood pressure,in order to control the change of blood pressure and prevent the occurrence of the Cardiovascular and Cerebrovascular diseases.It is suggested that screening out and health intervention strategies should be carried out in the Prehypertension.It is also suggested that more attention should be paid to the management of the Prehypertension in the current essantial public health services,through measuring the blood pressure in outpatient clinic based on the community,screening out the pre-hypertension population and giving the sustainable health management and intervention.According to the great health strategy of healthy China,the only way is to execute the strategy of early detection,early intervention,prevention of disease progression,reducing and delaying the occurrence of hypertension,then ensure to reduce the burden of the disease.Meanwhile,the research on health intervention mode,innovate and focus on changing behavior,sustainable healthy behavior keeping should be strengthened.And it is very important to build the mechanism of incentive and contract for the demanding side and suppliers,to promote the cooperation.And also,the continuous research on evaluation methods of health education,to make sure a reasonable and scientific policy could be formulated.Recommendations:To Strengthen the long-term intervention for the Prehypertension.