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Abstract：
OBJECTIVE: To project the 10-year clinical outcomes associated with single pill combination (SPC) therapies compared with multi-pill regimens for the management of hypertension in five countries (Italy, Russia, China, South Korea and Mexico).
METHODS: A microsimulation model was designed to project health outcomes between 2020 and 2030 for populations with hypertension managed according to four different treatment pathways: current treatment practices (CTP), single drug with dosage titration then sequential addition of other agents (start low and go slow, SLGS), free choice combination with multiple pills (FCC) and combination therapy in the form of a single pill (SPC). Model inputs were derived from the Global Burden of Disease 2017 dataset. Simulated outcomes of mortality, chronic kidney disease (CKD), stroke, ischemic heart disease (IHD), and disability-adjusted life years (DALYs) were estimated for 1,000,000 patients on each treatment pathway.
RESULTS: SPC therapy was projected to improve clinical outcomes over SLGS, FCC and CTP in all countries. SPC reduced mortality by 5.4% in Italy, 4.9% in Russia, 4.5% in China, 2.3% in South Korea and 3.6% in Mexico versus CTP and showed greater reductions in mortality than SLGS and FCC. The projected incidence of clinical events was reduced by 11.5% in Italy, 9.2% in Russia, 8.4% in China, 4.9% in South Korea and 6.7% in Mexico for SPC versus CTP.
CONCLUSIONS: Ten-year projections indicated that combination therapies (FCC and SPC) are likely to reduce the burden of hypertension compared with conventional management approaches, with SPC showing the greatest overall benefits due to improved adherence.
METHODS: A microsimulation model was designed to project health outcomes between 2020 and 2030 for populations with hypertension managed according to four different treatment pathways: current treatment practices (CTP), single drug with dosage titration then sequential addition of other agents (start low and go slow, SLGS), free choice combination with multiple pills (FCC) and combination therapy in the form of a single pill (SPC). Model inputs were derived from the Global Burden of Disease 2017 dataset. Simulated outcomes of mortality, chronic kidney disease (CKD), stroke, ischemic heart disease (IHD), and disability-adjusted life years (DALYs) were estimated for 1,000,000 patients on each treatment pathway.
RESULTS: SPC therapy was projected to improve clinical outcomes over SLGS, FCC and CTP in all countries. SPC reduced mortality by 5.4% in Italy, 4.9% in Russia, 4.5% in China, 2.3% in South Korea and 3.6% in Mexico versus CTP and showed greater reductions in mortality than SLGS and FCC. The projected incidence of clinical events was reduced by 11.5% in Italy, 9.2% in Russia, 8.4% in China, 4.9% in South Korea and 6.7% in Mexico for SPC versus CTP.
CONCLUSIONS: Ten-year projections indicated that combination therapies (FCC and SPC) are likely to reduce the burden of hypertension compared with conventional management approaches, with SPC showing the greatest overall benefits due to improved adherence.
摘要：
目标：在五个国家/地区，与多药治疗方案相比，与单药联合（SPC）疗法相关的10年临床结局（意大利，俄罗斯,中国,韩国和墨西哥）。
方法：设计了一个微观模拟模型，以预测2020年至2030年之间根据四种不同治疗途径管理的高血压人群的健康结果：当前的治疗实践（CTP），用剂量滴定的单一药物，然后依次添加其他药物(开始低，走慢，SLGS),自由选择多种药丸（FCC）和单一药丸（SPC）形式的联合治疗。模型输入来自2017年全球疾病负担数据集。死亡率的模拟结果，慢性肾脏病（CKD），中风,缺血性心脏病（IHD），估计每个治疗途径的1,000,000名患者的残疾调整生命年(DALYs)。
结果：SPC治疗预计比SLGS改善临床结局，FCC和CTP在所有国家。SPC在意大利将死亡率降低了5.4%，4.9%在俄罗斯，中国4.5%，与CTP相比，韩国为2.3％，墨西哥为3.6％，死亡率下降幅度大于SLGS和FCC。在意大利，临床事件的预计发生率降低了11.5%，俄罗斯9.2%，中国为8.4%，SPC与CTP相比，韩国为4.9%，墨西哥为6.7%。
结论：十年预测表明，与常规管理方法相比，联合治疗（FCC和SPC）可能会减轻高血压的负担，由于依从性的提高，SPC显示出最大的整体效益。
方法：设计了一个微观模拟模型，以预测2020年至2030年之间根据四种不同治疗途径管理的高血压人群的健康结果：当前的治疗实践（CTP），用剂量滴定的单一药物，然后依次添加其他药物(开始低，走慢，SLGS),自由选择多种药丸（FCC）和单一药丸（SPC）形式的联合治疗。模型输入来自2017年全球疾病负担数据集。死亡率的模拟结果，慢性肾脏病（CKD），中风,缺血性心脏病（IHD），估计每个治疗途径的1,000,000名患者的残疾调整生命年(DALYs)。
结果：SPC治疗预计比SLGS改善临床结局，FCC和CTP在所有国家。SPC在意大利将死亡率降低了5.4%，4.9%在俄罗斯，中国4.5%，与CTP相比，韩国为2.3％，墨西哥为3.6％，死亡率下降幅度大于SLGS和FCC。在意大利，临床事件的预计发生率降低了11.5%，俄罗斯9.2%，中国为8.4%，SPC与CTP相比，韩国为4.9%，墨西哥为6.7%。
结论：十年预测表明，与常规管理方法相比，联合治疗（FCC和SPC）可能会减轻高血压的负担，由于依从性的提高，SPC显示出最大的整体效益。
