An Health Economic Evaluation For Hypertension Management In Communities

The first part:An health economic evaluation for hypertension management in communities:Background and objectiveAlong with the economical and social development, the incidence and mortality of cardiovascular disease (CVD) now has been growing steadily from year to year. Hypertension and diabetes are the most important modifiable risk factor among many CVD risk factors. Now, there are many researches about hypertension community management. Evidences from domestic and foreign indicated that community management can improve the awareness, treatment, and control rates of hypertension, and prevent CVD effectively. Hypertension community management need massive manpower and resources, but whether it is cost-benefit and cost-effectiveness is not well known, in China.Subjects and methodsCluster sampling was used to choose participants. Finally, this study included 8326 samples from 5 provinces in China,3967 samples in intervention group,4359 samples in control group. Through study the blood pressure stages, the cost of medicine and the quality-adjusted life year of hypertension in order to make cost-effectiveness analysis. Chi-square test, t test were performed In univariate analysis, and multivariate statistical analysis was used to analyses the cost-effectiveness of hypertension community management.ResultsThe results showed that community management intervention for hypertension improved the awareness rates of risk factors, hypertension and its complications over one year duration. The frequencies of blood pressure measurement and with dietary modification were higher in management group than control group. In order to analyze the effect of blood pressure control, we classified the survey sites into intensive management group and ordinary management group. Intensive management of hypertension can decrease blood pressures and increase hypertension control rate. Systolic blood pressure and diastolic blood pressure were significantly lower in intensive management group than its control group (137.03mmHg/81.82mmHg vs. 143.93mmHg/85.25mmHg, P<0.01). The control rate of hypertension was higher in intensive management group than control group (56.67%vs.38.34%, P<0.01). The waist and BMI index were lower in intensive management group than control group. The effect size of blood pressure control did not differ between ordinary management group and control group, but some blood lipoids improved in ordinary management than control group. The treatment rate (at least 1 visit per 3 month) and compliance rate were higher in intervention group than control group. The treatment rate in community health service centers or village health stations was higher in intervention group than control group. Participates expressed more appreciation for Community Health Service Center in intervention group than control group. The norm for SF-36v2 in the 1998 general U.S. population was used to calculate the life quality scores. Physiological health score was higher in the intervention group than control group (46.89 vs.46.48, P<0.05). Psychological health score, however was lower in the intervention group than control group (53.59 vs.54.09, P=0.01). Physiological health score and psychological healthy score in intervention group in urban were higher than control group. Participants in urban had a higher physiological health score but a lower psychological score than the countryside participants. The SF-6D score was higher in the management group in urban than control group (0.793 vs.0.789, P=0.18). The drug treatment cost was 622(593-650) Yuan per hypertension per year, and there was no significant difference at the drug treatment cost between two groups. The drug treatment cost for hypertensive who toke medicine was 702(670-734) Yuan per person per year, and the cost was lower in intervention group than control group (689(646-73l)Yuan vs.714(667-762)Yuan, P=0.42). The drug treatment cost for hypertensive who toke medicine was higher in urban than countryside (728(691-765) Yuan vs.407(364-451) Yuan, P<0.01). The hospital admission rate of hypertension or its'complications was 12.18%. The hospital expense of in-patient with hypertension was 9264 (8117-10412)Yuan per person, and it was lower in management group than control group(7584 (6406-8761)Yuan vs.11028 (9035-13021)Yuan, p<O.01). The hospital expense of hypertension among patients with and without hospitalization was 1065 (919-1211)Yuan per person per year, and it was lower in management group than control group(937(772-1101) Yuan) vs. 1182(946-1417)Yuan, P=0.10). The hospital expenses of hypertension was higher in urban than countryside, and it was higher in male than female. The direct medical cost of hypertension was 2275(2098-2452)Yuan per person per year, and it was lower in management group than control group(2165(1961-2369)Yuan vs.2375(2094-2657) Yuan,P=0.24). Hypertensive patients in urban had more expensive direct medical cost than those in countryside (2801(2552-3050) Yuan vs.1255(1071-1439) Yuan, P<0.01). The drug treatment cost for each well-controlled hypertensive was 2089 Yuan per year, and it was higher in urban management group than control group (D1=848 Yuan). But it was lower in intervention group than control group in countryside (D=981 Yuan). The drug treatment cost for each well-controlled hypertensive was lower in management group than control group in Changshu, Jiangsu province and Chegndu, Sichuan province (D=215, D=2131, respectively), and it showed a significant cost-benefit.ConclusionThe results demonstrated that the community hypertension management achieved good cost-effectiveness. According to the characteristics of hypertension community management in present, hypertensions and general practitioners from the community and doctors who care chronic illness from Centers for Disease Control and Prevention provided precious policy suggestions about how to manage hypertension, which will help us improve hypertension community management.The second part:Effect of mobile phone intervention for diabetes on glycaemic control:a meta-analysisA total of 22 trials were selected for the review. Meta-analysis among 1657 participants showed that mobile phone interventions for diabetes self-management reduced HbAlc values by a mean of 0.51%(95%confidence interval [CI],0.33%-0.69%) over a median of 6 months follow-up duration. In subgroup analysis,11 studies among type 2 diabetes patients reported significantly greater reduction in HbAlc than studies among type 1 diabetes patients (0.81%vs.0.27%, P=0.02). The effect of mobile phone intervention did not significantly differ by other participants'characteristics or intervention strategies. Results pooled from the included trials provided strong evidence that mobile phone intervention led to statistically significant improvement in glycemic control and self-management in diabetes care, especially for type 2 diabetes patients.