| ObjectiveThe data source of this study is China Health and retirement longitudinal survey(CHARLS).Through the extraction and analysis of the data from 2011 to 2018 in the database,we can understand the distribution of chronic diseases,the prevalence of cardiovascular diseases and the population composition of cardiovascular diseases among the middle-aged and elderly people in China;Through univariate analysis and logistic regression analysis,to explore the influencing factors of TCM Intervention in middle-aged and elderly people with cardiovascular disease;By analyzing the mortality and cost information between TCM Intervention and Western medicine intervention in CHARLS database,the economic burden and survival status of patients with cardiovascular disease between TCM Intervention and Western medicine intervention were understood;By constructing Markov model,this paper analyzes the cost-effectiveness between traditional Chinese medicine intervention and Western medicine intervention in the treatment of cardiovascular disease in middle-aged and elderly people.MethodsBy using the method of literature analysis,we searched CNKI,WF,VIP,Springer and PubMed databases to understand the influencing factors of medication behavior of middleaged and elderly patients with cardiovascular disease.Through the analysis of relevant data in CHARLS database,the prevalence of chronic diseases of middle-aged and elderly people in China from 2011 to 2018,the prevalence of cardiovascular diseases of middle-aged and elderly people in China in 2018,and the composition of cardiovascular disease patients of middle-aged and elderly people in China in 2018 were understood;Through univariate analysis and logistic regression analysis,the influencing factors of traditional Chinese medicine intervention treatment for middle-aged and elderly patients with cardiovascular disease in 2018 were studied;Through the data extraction of CHARLS database in 2015 and 2018,Markov model was constructed to simulate and analyze the economy of traditional Chinese medicine intervention on cardiovascular disease of middle-aged and elderly people in China.Contents1.through the analysis of data from 2011 to 2018 in CHARLS database,we can understand the overall prevalence of chronic diseases of middle and old people in China from 2011 to 2018,the prevalence of cardiovascular diseases in middle and old people in 2018 and the basic characteristics of cardiovascular disease patients in middle and old people in 2018.2.through the data analysis of 2018 in CHARLS database,we can understand the influencing factors of TCM Intervention in cardiovascular diseases in middle and old people.The intervention treatment of Chinese medicine in middle and old people with cardiovascular disease in 2018 was described and analyzed by single factor analysis and logistic regression analysis,and the influencing factors of TCM intervention were explored.3.through the data extraction in 2015 and 2018 in CHARLS database,the Markov model simulation is constructed to analyze the cost utility of TCM Intervention and Western medicine intervention in the long-term treatment of cardiovascular diseases in the middle and old people in China,and to explore the economic effect of TCM Intervention in the treatment of cardiovascular diseases in the middle and old,and through sensitivity analysis,the influence of various factors on simulation results is explored.ResultsBased on the data analysis of CHARLS database from 2011 to 2018,it is found that the prevalence of chronic diseases in middle-aged and elderly people in China from 2011 to 2018 is on the decline,but the prevalence of cardiovascular diseases is on the rise.The prevalence of cardiovascular diseases in 2018 ranks first among chronic diseases.According to the data analysis in 2018,the prevalence of cardiovascular diseases among middle-aged and elderly people in China is in the following aspects:gender,age,type of residence,type of household registration,education level,marital status,living habits(smoking,drinking,exercise,sleep,etc.),physical condition(disability,chronic diseases,etc.),medical insurance,medical satisfaction,etc.There were statistical differences in these aspects(P<0.05).The results of univariate analysis of traditional Chinese medicine intervention for middle-aged and elderly patients with cardiovascular disease in 2018 show that the traditional Chinese medicine intervention for patients is related to several factors:type of residence,type of household registration,education level,medical insurance,liver disease and mental disease,blindness/semi blindness,course of cardiovascular disease,total family expenditure,recurrence and hospitalization,sleep,and medical satisfaction(P<0.05).Logistic regression analysis showed that the type of residence,free medical care,education level,arthritis,mental illness,blindness/semi blindness and medical satisfaction were the more direct influencing factors for the use of traditional Chinese medicine intervention in middleaged and elderly patients with cardiovascular disease.The middle-aged and elderly people with higher education level were more likely to choose traditional Chinese medicine intervention treatment,and the population with primary education was 1.422 times of that without education(β=352,P=0.001),and 1.363 times of those without secondary education(β=309,P=0.013),higher education was 1.822 times of the uneducated(β=0.6,P=0.027);The use of traditional Chinese medicine intervention in the treatment of middle-aged and elderly patients with cardiovascular disease who are blind/semi blind is 1.433 times as much as those who are not blind/semi blind(β=0.173,P=0.037);The patients with mental illness were 1.877 times more likely to use TCM intervention than those without mental illness(β=0.63,P=0.004);2.853 times of the patients without medical insurance(β=1.048,P=0.012);Compared with patients with cardiovascular disease who had high satisfaction with medical treatment,patients with cardiovascular disease who had general and low satisfaction with medical treatment were more likely to use traditional Chinese medicine,The satisfaction of patients with general satisfaction is 1.228 times that of patients with satisfaction(β=205,P=0.02),and the patients who were not satisfied were 1.584 times as satisfied(β=0.46,P=0.00).Based on the analysis of the mortality of vascular diseases in CHARLS database center from 2015 to 2018,it was found that the total mortality of TCM Intervention(including TCM alone intervention and TCM combined with western medicine intervention)was 6.69%,and the total mortality of Western medicine intervention was 8.39%,The mortality rate of middleaged and elderly people with cardiovascular disease treated by traditional Chinese medicine intervention was lower than that treated by western medicine intervention(P=0.0349);In 2018,it was found that the health utility value of middle-aged and elderly patients without cardiovascular events in China was 0.8359 ± 1022 QALYs,the health utility value of middleaged and elderly patients with cardiovascular disease recurrence and hospitalization was 0.8042 ± 1103 QALYs,the health utility value of middle-aged and elderly patients with cardiovascular disease recurrence and hospitalization will decrease by 0.0317 QALYs,the decrease range is 3.79%;The average annual outpatient cost of TCM intervention patients was 29330.2 yuan,and that of Western medicine intervention patients was 25980.5 yuan;The average annual self-treatment cost of patients with traditional Chinese medicine intervention was 6839.7 yuan,and that of patients with western medicine intervention was 4734.9 yuan;The average hospitalization expenses of TCM intervention patients were 17674.1 yuan and 1652.7 yuan,while the average hospitalization expenses of Western medicine intervention patients were 19763.8 yuan and 2373.0 yuan;The average length of stay of patients with traditional Chinese medicine intervention was 13.17 days,and the cost of work delay(calculated by the human resource method,the per capita GDP was 64520.70 yuan in 2018)was 2327.3 yuan.The average length of stay of patients with western medicine intervention was 11.22 days,and the cost of work delay was 1982.8 yuan;The average indirect medical cost of TCM intervention patients was 13824.8 yuan,while that of Western medicine intervention patients was 11229.0 yuan;The average total cost of traditional Chinese medicine intervention was 33357.0 yuan per patient,and that of Western medicine intervention was 28039.7 yuan per patient.The total cost of traditional Chinese medicine intervention was higher,with an annual average cost of 5317.3 yuan higher.The results of Markov model analysis showed that there was no economy in the first three years(ICER was more than 3 times of GDP per capita in 2018);During the 4-17 years of treatment,the increased cost of TCM intervention is acceptable(ICER is between 1-3 times of GDP per capita).From the 18th year,the increased cost is completely worthwhile(ICER is less than 1 times of GDP per capita),and TCM intervention is economical;After 18 years of treatment,compared with western medicine intervention,Chinese medicine intervention in the treatment of cardiovascular disease can get 1.6325qalys,the additional payment is 104217.97 yuan,ICER is 63839.98 yuan/QALY;After 45 years of treatment,the average treatment cost of TCM intervention group was 517622.17 yuan,and QALYs was 15.77 years;The average treatment cost of Western medicine intervention group was 385219.29 yuan,and QALYs was 12.78 years.Compared with western medicine intervention,the cost of traditional Chinese medicine intervention increased by 132402.88 yuan,and 2.98 QALYs were obtained,with ICER value of 44401.04 yuan/QALY.According to the threshold recommended by who for pharmacoeconomics evaluation results,referring to China’s per capita GDP(64520.70 yuan)in 2018,the ICER value is less than one time of per capita GDP.It is considered that TCM intervention is an economic treatment scheme,and the longer the treatment time,the more economic the scheme.The single factor sensitivity results showed that the annual outpatient cost of TCM Intervention,discount rate and annual outpatient cost of Western medicine intervention had a greater impact on the ICER value of the final result,while the annual hospitalization cost,annual indirect medical cost,annual work delay cost,annual self-treatment cost and disease state utility had a smaller impact on the ICER value of the final result;The results of probability sensitivity analysis showed that when the value of willingness to pay was 0 yuan,the probability that TCM intervention was economical was 40.24%;When the value of willingness to pay was 15460.99 yuan,the economic probability of TCM Intervention and Western medicine intervention was 50%;When the value of willingness to pay is 1 times of per capita GDP in 2018,the probability of economic effectiveness of TCM intervention is 72.35%.When the value of willingness to pay is 3 times of per capita GDP in 2018,the probability of economic effectiveness of TCM intervention is 86.32%,which indicates that the simulation results of the model are relatively stable.ConclusionsBased on the analysis,the following conclusions are drawn:1.From 2011 to 2018,the prevalence of chronic diseases in middle-aged and elderly people in China showed a downward trend,but the prevalence of cardiovascular diseases showed an upward trend,and cardiovascular disease is still the focus of chronic disease prevention and control in the future;The health behavior of middle-aged and elderly patients with cardiovascular disease is better,and the proportion of Chinese medicine treatment is low;2.There are many factors influencing the choice of TCM Intervention Treatment for middle-aged and elderly patients with cardiovascular disease,among which education level,type of residence,blindness/semi blindness,mental disease,arthropathy,medical satisfaction and public medical care are the significant influencing factors;3.TCM Intervention(including TCM alone intervention and TCM combined with western medicine intervention)can reduce the mortality of middle-aged and elderly patients with cardiovascular disease;In 2018,the cost of traditional Chinese medicine in the treatment of cardiovascular diseases for the middle-aged and elderly people is higher;In the long-term(≥18 years)treatment,the use of traditional Chinese medicine intervention in the treatment of cardiovascular disease is an economic treatment.Discussion and LimitationsThe research data are based on the original research data in the database of China Health and retirement longitudinal survey(CHARLS),a large-scale interdisciplinary survey project sponsored by National Development Research Institute of Peking University and implemented by China Social Science Survey Center of Peking University from 2011 to 2018,And it is in line with the population information and medical habits of Chinese citizens.The research samples can well represent the real treatment situation of middle-aged and elderly patients with cardiovascular disease in China,and the external authenticity is high,and the research results have good extrapolation.Since the questionnaire design of CHARLS database itself is not aimed at the research problems in the study,there are some errors in the process of cost information,quality of life calculation and transfer probability acquisition,and there are no clear disease stages and detailed disease types in the study,so there are some limitations in the model construction. |
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