工作场所4种高血压干预措施的成本效果分析

Cost-effectiveness analyses on four intervening regiments for hypertension in workplace

目的对工作场所进行高血压干预的4种药物组合的成本效果进行分析。方法自2009-04-2010-05开始对开滦集团有限责任公司井下及井下辅助单位在岗原发性高血压职工共4090例[男性4023例,女性67例,年龄(45.5±6.5)岁]进行综合干预。干预措施包括免费发放降压药物,宣传教育和行政干预。降压药为下列组合之一:第1组(n=1115):尼群地平(5mg,2次/d)+卡托普利(12.5mg,2次/d);第2组(n=704):尼群地平(5mg,2次/d)+螺内酯(20mg,1次/d);第3组(n=794):氢氯噻嗪(12.5mg,1次/d)+卡托普利(12.5mg,2次/d);第4组(n=1477):氢氯噻嗪(12.5mg,1次/d)+螺内酯(20mg,1次/d)。干预期间每2周随访一次并测量血压。所有研究对象平均随访1年,观察干预前后各组疗效情况,并运用药物经济学原理进行成本-效果分析。结果经过1年的综合干预,不同药物组合干预高血压的成本效果差异有统计学意义。以第2组(尼群地平+螺内酯组)的治疗有效率最低(61.51%),第4组(氢氯噻嗪+螺内酯组)的治疗有效率最高(80.37%),第1组(尼群地平+卡托普利组)和第3组(氢氯噻嗪+卡托普利组)的治疗有效率差异无统计学意义(χ2=0.074,P>0.05)。第3组(氢氯噻嗪+卡托普利组)的干预成本最低,第4组(氢氯噻嗪+螺内酯组)的干预成本适中。成本效果分析显示,与干预成本最低的第3组相比,每提高1个百分点的降压有效率,第4组的年干预成本增加1.72元;第4组的收缩压每降低1mmHg,年干预成本需增加7.25元,舒张压每降低1mmHg,年干预成本需增加10.17元;第1组和第2组降压效果不及第3组,但成本却比第3组要高。结论工作场所进行高血压干预的4种药物组合中,从经济学和药物治疗学角度进行综合分析,氢氯噻嗪+螺内酯组干预措施的成本效果最佳。

Abstract： Objective To analysis the cost-effectiveness of four drug combinations for hypertension intervention in workplace. Methods From April 2009 to May 2010,a total of 4023 [4023male,67 female, age （45.5±6.5）]pri- mary hypertensive active staff who worked in underground and underground ancillary units of Kailuan Group limited liability company received comprehensive interventions. Interventions consisted of free distribution of antihyperten- sive drugs, communication and education, and administrative intervention. Antihypertensive drugs included the fol- lowing combinations： Group 1 （n= 1115）： nitrendipine 5 rag/bid plus captopril 12.5 mg/bid; QGroup 2 （n= 704） ： the nitrendipine 5 rag/bid plus spironolactone 20 mg/d; Group 3 （n= 794}： hydrochlorothiazide 12.5 mg/d plus captopril 12. 5 mg/bid; @Group 4 （n= 1477） ： the hydrogen hydrochlorothiazide I2.5 mg/d plus spironolactone 20 mg/d. During the intervention, the blood pressure was measured every two weeks. All the subjects were fol- lowed-up for one year on average. The curative effects were observed before and after the intervention, and the cost-effectiveness analyses were conducted by the principles of pharmaeoeconomics. Results There were signifi- cant differences in cost-effectiveness between groups receiving different drug combination interventions after one year. The total effective rate of Group 2 （61.51%） was the lowest, while that of the Group 4 {80.37 %} was the highest. There was no statistic difference in the total effective rates between Group 1 and Group 3 （i=2 = 0. 074, P=0.05}. The intervention cost of Group 3 was the lowest, and that of the Group 4 was moderate. Cost-effec- tiveness showed that, compared with that of the Group 3, the annual intervention cost of Group 4 （hydrochlorothiaz- ide plus spironolactone） increased 1.72 yuan for every one percentage increase in its hypotensive effect; the annual intervention cost of Group 4 increase 7.25 yuan for every 1 mm Hg decrease in systolic blood pressure （SBP） and 10.17 yuan for every 1 mm Hg decrease in diastolic blood pressure （DBP）. The cost of Group 1 and Group 2 were higher than that of Group 3 without better hypotensive effects. Conclusions According to the comprehensive anal- ysis of economics and pharmacotherapeutics, Group 4 {hydrochlorothiazide plus spironolactone） shows the best re- suits of cost-effectiveness among the four antihypertensive drug combination interventions in the workplace.