PDF(Pubmed)
Abstract：
BACKGROUND: While a population-wide strategy involving lifestyle changes and a high-risk strategy involving pharmacological interventions have been described, the recently proposed personalized medicine approach combining both strategies for the prevention of hypertension has increasingly gained attention. However, a cost-effectiveness analysis has been hardly addressed. This study was set out to build a Markov analytical decision model with a variety of prevention strategies in order to conduct an economic analysis for tailored preventative methods.
METHODS: The Markov decision model was used to perform an economic analysis of four preventative strategies: usual care, a population-based universal approach, a population-based high-risk approach, and a personalized strategy. In all decisions, the cohort in each prevention method was tracked throughout time to clarify the four-state model-based natural history of hypertension. Utilizing the Monte Carlo simulation, a probabilistic cost-effectiveness analysis was carried out. The incremental cost-effectiveness ratio was calculated to estimate the additional cost to save an additional life year.
RESULTS: The incremental cost-effectiveness ratios (ICER) for the personalized preventive strategy versus those for standard care were -USD 3317 per QALY gained, whereas they were, respectively, USD 120,781 and USD 53,223 per Quality-Adjusted Life Year (QALY) gained for the population-wide universal approach and the population-based high-risk approach. When the ceiling ratio of willingness to pay was USD 300,000, the probability of being cost-effective reached 74% for the universal approach and was almost certain for the personalized preventive strategy. The equivalent analysis for the personalized strategy against a general plan showed that the former was still cost-effective.
CONCLUSIONS: To support a health economic decision model for the financial evaluation of hypertension preventative measures, a personalized four-state natural history of hypertension model was created. The personalized preventive treatment appeared more cost-effective than population-based conventional care. These findings are extremely valuable for making hypertension-based health decisions based on precise preventive medication.
METHODS: The Markov decision model was used to perform an economic analysis of four preventative strategies: usual care, a population-based universal approach, a population-based high-risk approach, and a personalized strategy. In all decisions, the cohort in each prevention method was tracked throughout time to clarify the four-state model-based natural history of hypertension. Utilizing the Monte Carlo simulation, a probabilistic cost-effectiveness analysis was carried out. The incremental cost-effectiveness ratio was calculated to estimate the additional cost to save an additional life year.
RESULTS: The incremental cost-effectiveness ratios (ICER) for the personalized preventive strategy versus those for standard care were -USD 3317 per QALY gained, whereas they were, respectively, USD 120,781 and USD 53,223 per Quality-Adjusted Life Year (QALY) gained for the population-wide universal approach and the population-based high-risk approach. When the ceiling ratio of willingness to pay was USD 300,000, the probability of being cost-effective reached 74% for the universal approach and was almost certain for the personalized preventive strategy. The equivalent analysis for the personalized strategy against a general plan showed that the former was still cost-effective.
CONCLUSIONS: To support a health economic decision model for the financial evaluation of hypertension preventative measures, a personalized four-state natural history of hypertension model was created. The personalized preventive treatment appeared more cost-effective than population-based conventional care. These findings are extremely valuable for making hypertension-based health decisions based on precise preventive medication.
摘要：
背景：虽然已经描述了涉及生活方式改变的全人群策略和涉及药物干预的高风险策略，最近提出的将两种预防高血压的策略结合起来的个性化医学方法越来越受到关注.然而,成本效益分析几乎没有得到解决。本研究旨在建立具有各种预防策略的马尔可夫分析决策模型，以便对量身定制的预防方法进行经济分析。
方法：使用马尔可夫决策模型对四种预防策略进行了经济分析：常规护理，基于人口的普遍方法，基于人群的高风险方法，和个性化的策略。在所有的决定中,对每种预防方法中的队列进行了全程追踪,以阐明基于四态模型的高血压自然史.利用蒙特卡罗模拟，进行了概率成本-效果分析.计算了增量成本效益比，以估计节省额外寿命年的额外成本。
结果：个性化预防策略与标准护理策略的增量成本效益比（ICER）为每QALY-3317美元，而他们是，分别,每个质量调整生命年（QALY）获得120,781美元和53,223美元，用于全民普遍方法和基于人群的高风险方法。当支付意愿的最高比率为300,000美元时，对于通用方法，具有成本效益的可能性达到74％，对于个性化预防策略几乎可以肯定。对个性化策略与总体计划的等效分析表明，前者仍然具有成本效益。
结论：为了支持健康经济决策模型，用于高血压预防措施的财务评估，我们建立了个性化的四状态高血压自然史模型.个性化预防治疗似乎比基于人群的常规护理更具成本效益。这些发现对于基于精确预防药物的基于高血压的健康决策非常有价值。
方法：使用马尔可夫决策模型对四种预防策略进行了经济分析：常规护理，基于人口的普遍方法，基于人群的高风险方法，和个性化的策略。在所有的决定中,对每种预防方法中的队列进行了全程追踪,以阐明基于四态模型的高血压自然史.利用蒙特卡罗模拟，进行了概率成本-效果分析.计算了增量成本效益比，以估计节省额外寿命年的额外成本。
结果：个性化预防策略与标准护理策略的增量成本效益比（ICER）为每QALY-3317美元，而他们是，分别,每个质量调整生命年（QALY）获得120,781美元和53,223美元，用于全民普遍方法和基于人群的高风险方法。当支付意愿的最高比率为300,000美元时，对于通用方法，具有成本效益的可能性达到74％，对于个性化预防策略几乎可以肯定。对个性化策略与总体计划的等效分析表明，前者仍然具有成本效益。
结论：为了支持健康经济决策模型，用于高血压预防措施的财务评估，我们建立了个性化的四状态高血压自然史模型.个性化预防治疗似乎比基于人群的常规护理更具成本效益。这些发现对于基于精确预防药物的基于高血压的健康决策非常有价值。
