Cost-effectiveness Analysis Of Antihypertensive Drugs In Rural Areas Of Northern Jiangsu Province

Objective:To explore the cost-effectiveness of common drug regimens in high-risk patients of standardized hypertension management group in rural areas of Northern Jiangsu Province,and to provide economic research basis for Drug Guidelines in rural areas of Northern Jiangsu Province.Methods:This study adopted the method of historical cohort study,selected 34community health service centers/township hospitals under the jurisdiction of four bases(Haian County in Nantong,Lianshui County in Huai’an,Jianye District in Nanjing and Peixian County in Xuzhou)of Jiangsu hypertension standardized management group from 2010 to 2012 to establish a database.The collection of baseline data,inclusion and exclusion criteria of patients,layered treatment principles,standardized management measures,follow-up management principle and quality control were strictly implemented in accordance with the work manual of standardized management of hypertension.In the standardized management group,there were 6209 high-risk patients with hypertension,3622 of whom received drug treatment.Nine common drug treatment schemes are arranged by the number of people:compound preparation(7),ACEI alone(8),CCB alone(2),CCB+ACEI(4),diuretic alone(3),CCB+compound preparation(6),compound preparation+Chinese patent medicine(5),ACEI+compound preparation(9),diuretic+CCB(1).Patients who changed their medication,stopped taking medication and had unknown baseline medication were excluded Data.According to the follow-up data of one year after standardized management,the blood pressure monitoring of high-risk population in the 12th month was judged to be up to standard.SPSS software was used to analyze the data,calculate the control rate of nine drug regimens,and calculate the annual cost of medication per capita of nine drug regimens according to the information such as the number,specification and unit price of the drug taken by the patients in the baseline data.Multiple sample means were compared,and the homogeneity test of variance and one-way ANOVA were carried out,and the q-test was used to compare the means.The chi-square test is used to compare the sample rate,and the Schefféconfidence interval method is used to compare multiple sample rates.Finally,the cost-effectiveness analysis was used to evaluate the cost-effectiveness of nine drug regimens.Results:the control rate of blood pressure in 3009 patients was 57.36%,among which the control rate of diuretic+CCB was the highest(68.63%);the annual cost of medication per capita was 180.38[95%CI:(168.73,192.03)]yuan,the annual cost of CCB alone per capita was 305.01(258.89,351.14)yuan,and the annual cost of ACEI alone per capita was the lowest[138.17(111.94,164.41)]yuan;the result of Levene’s variance homogeneity test was F=42.494,P<0.001;The results of one-way ANOVA were F=13.232,P<0.001;the q-test of the two comparisons showed that there was no statistical significance in the mean of each group in the two equilibrium subsets,and there was statistical significance in the mean of each group between the subsets,i.e.2 and 5;1,3,4,6,7,8,9,there was no statistical significance in the difference between the two group,but 2 or 5 and 1,3,4,6,7,8,9 There was statistical significance;the comparison of multiple sample rates calculatedχ~2=30.1181,P<0.005;the 95%confidence interval of the difference between the two rates was calculated,and if the confidence interval included 0,it could be considered that there was no difference between the two sample rates.The results showed that the 95%confidence interval of the difference between CCB alone and ACEI alone in blood pressure control rate was(0.0154,0.2560);There are three drug regimens with low cost-effectiveness:diuretics alone(2.33),diuretics+CCB(2.46),CCB+ACEI(2.52).Based on the analysis of incremental cost-effectiveness ratio,for every 1%increase of blood pressure control rate in diuretic+CCB group,the cost of diuretic group alone will be 3.46 yuan,while that of CCB+ACEI group will only be 2.08 yuan.The results of sensitivity analysis show that the order of incremental cost-effectiveness ratio of three kinds of drug regimens remains the same.Conclusion:It can be concluded that the blood pressure control rate and annual cost per capita of high-risk patients are different in nine drug regimens,among which the annual cost per capita of CCB alone is higher than that of other groups[except compound+Chinese patent medicine];the annual cost per capita of compound+Chinese patent medicine is higher than that of other groups[except CCB];in the high-risk group of hypertension,he rate of pressure control of CCB alone is higher than ACEI alone;the cost-effectiveness of three drug regimens,diuretic+CCB,CCB+ACEI,was relatively low,which belonged to a relatively high-quality drug treatment scheme.The evaluation results can be used as an economic basis for guiding the use of drugs and optimizing standardized management mode in rural areas of Northern Jiangsu.