深圳市单纯血脂异常及合并高血压或糖尿病患者社区健康管理成本效果评价

The cost-effectiveness evaluation of community health management for patients with simple dyslipidemia or hypertension or diabetes mellitus

目的 评价单纯血脂异常者、血脂异常合并高血压或糖尿病者社区健康管理的效果及成本效果。方法 2017年4—5月,采用多阶段随机抽样方法选取深圳市22个社区健康服务中心,随机分为干预组(12个)和对照组(10个),从中随机选取单纯血脂异常者、血脂异常合并高血压或糖尿病者1 100例作为管理对象。对照组提供高血压或糖尿病基本公共卫生服务随访;干预组联合开展血脂异常管理,干预时间1年,终期评估共897例全程参与,采用倍差法评估干预净效果,以低密度脂蛋白胆固醇(LDL-C)干预效果为结局指标,计算成本效果比和增量成本效果比。结果 单纯血脂异常者总胆固醇(TC)、LDL-C的干预净效果分别为0.496、0.564 mmol/L,血脂异常合并高血压者TC、甘油三酯(TG)、LDL-C的干预净效果分别为0.441、0.358、0.392 mmol/L,血脂异常合并糖尿病者TC、TG、LDL-C、空腹血糖(FPG)干预净效果分别为0.479、0.278、0.470、0.815 mmol/L,血脂异常合并高血压糖尿病者TC、TG、LDL-C、FPG的干预净效果分别为0.589、0.418、0.432、1.198 mmol/L,以上结果均有统计学意义(P值均<0.05)。以LDL-C干预效果为结局指标,社区健康服务中心开展血脂异常管理干预,干预组单纯血脂异常者、血脂异常合并高血压者、血脂异常合并糖尿病者、血脂异常合并高血压糖尿病者每降低1 mmol/L的成本效果比分别为296.71、360.44、361.11、583.45元,相应的增量成本效果比分别为111.06、23.34、24.83、30.09元。结论 社区实施血脂异常管理干预,有良好干预效果和成本效果,增量成本效果比以血脂异常合并高血压或糖尿病者较好。

Objective To evaluate the management effect and cost-effectiveness of community health management for patients of simple dyslipidemia or complicated with hypertension or diabetes mellitus. Methods From Apr to May 2017,22 community health service centers in Shenzhen were selected by multi-stage random sampling method and randomly divided into intervention group(12 centers) and control group(10 centers),a total of 1 100 patients of simple dyslipidemia, or complicated with hypertension or diabetes mellitus were selected by random sampling method. The control group was provided with follow-up visits to essential hypertension and diabetes;while the intervention group was provided with additional joint dyslipidemia management. After 1 year intervention, the double difference method was used to evaluate the final net effect of the intervention among 897 participated subjects, in which low-density lipoprotein cholesterol(LDL-C) was used as the outcome indicator, and the cost-effect ratio and the incremental cost-effect ratio were calculated. Results The final net effects of the intervention for total cholesterol(TC) and LDL-C in patients with simple dyslipidemia were 0.496 mmol/L and 0.564 mmol/L,respectively;the final net effects of the intervention for TC,triglycerides(TG) and LDL-C of patients of dyslipidemia complicated with hypertension were 0.441 mmol/L,0.358 mmol/L and 0.392 mmol/L,respectively;the final net effects of the intervention for TC,TG,LDL-C and fasting plasma glucose(FPG) of patients with dyslipidemia and diabetes were 0.479 mmol/L,0.278 mmol/L,0.470 mmol/L and 0.815 mmol/L,respectively;the final net effects of the intervention for TC,TG,LDL-C and FPG were 0.589 mmol/L,0.418 mmol/L,0.432 mmol/L and 1.198 mmol/L,respectively in patients of dyslipidemia complicated with hypertension and diabetes;all above differences were statistically significantly(all P<0.05).Taking LDL-C as outcome indicator, the cost-effectiveness ratios of community dyslipidemia health management for patients with simple dyslipidemia, dyslipidemia complicated with hypertension, dyslipidemia complicated with diabetes mellitus, dyslipidemia complicated with both hypertension and diabetes mellitus were 296.71,360.44,361.11 and 583.45 yuan for every 1 mmol/L decreasement, and the corresponding incremental cost-effectiveness ratios of were 111.06,23.34,24.83 and 30.09 yuan, respectively. Conclusion The dyslipidemia health management by community has good intervention effect and cost effectiveness. Incremental cost effectiveness is better than those with dyslipidemia complicated with hypertension and diabetes.