非卧床血压监测与临床血压监测相比的经济影响:模拟模型。

IF 2.4 Q2 HEALTH CARE SCIENCES & SERVICES Health Services Insights Pub Date : 2024-09-24 eCollection Date: 2024-01-01 DOI:10.1177/11786329241283797
Michelle A Hayek, Alejandro Catacora, Mark A Lawley, Hye-Chung Kum, Robert L Ohsfeldt
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引用次数: 0

摘要

背景:非卧床血压监测 (ABPM) 被认为是正确诊断高血压的黄金标准。然而,在美国获得 ABPM 的机会有限,而且商业健康计划的覆盖范围仍不确定,这可能会限制商业保险患者获得 ABPM:本研究旨在评估在美国使用 ABPM 与临床血压监测 (CBPM) 相比在 5 年时间内的净成本影响:使用马尔可夫模型,我们从美国医疗保健系统的角度出发,估算了在一个由 1000 名患者组成的假设队列中,使用 ABPM 确认原发性高血压的既往诊断,使用 CBPM 避免白大衣高血压 (WCH) 治疗的 5 年累计成本影响。该模型的概率和成本输入来自现有文献。基础案例模型参数根据不同情况而变化:基本情况结果表明,使用 ABPM 代替 CBPM 5 年共可节省 348028 美元,反映出平均每人每年 (PPPY) 可节省 70 美元的成本。在敏感性分析中,几乎所有病例都显示 ABPM 比 CBPM 更能节省成本,在高血压治疗成本最高的模型中,ABPM 节省的成本高达 228 美元/人-年。回归结果显示,如果 ABPM 的年支付率为 100 美元或更低,且每年的高血压治疗费用为 300 美元,则 ABPM 比 CBPM 更能节约成本:在我们的模拟模型中发现,使用 ABPM 而非 CBPM 有可能节省成本,这突出表明有必要使用真实世界的数据进行确证研究,以支持更多使用 ABPM 作为高血压的标准诊断方法。
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Economic Impact of Ambulatory Blood Pressure Monitoring Compared With Clinical Blood Pressure Monitoring: A Simulation Model.

Background: Ambulatory blood pressure monitoring (ABPM) is considered the gold standard for proper diagnosis of hypertension. Yet, access to ABPM in the U.S. is limited, and the extent of coverage by commercial health plans remains uncertain, potentially limiting access to ABPM among commercially insured patients.

Objective: This study aims to assess the net cost impact of using ABPM in comparison to clinical blood pressure monitoring (CBPM) in the U.S. over a 5-year time period.

Design methods: Using a Markov Model, we estimate the 5-year cumulative cost impact of using ABPM to confirm a prior diagnosis of primary hypertension using CBPM to avoid treatment for white-coat hypertension (WCH) in a hypothetical cohort of 1000 patients from a U.S. healthcare system perspective. The probability and cost inputs for the model were derived from available literature. Base-case model parameters were varied to account for different scenarios.

Results: Base-case results indicate using ABPM instead of CBPM over 5 years saves a total of $348,028, reflecting an average per-person-per-year (PPPY) cost saving of $70. In sensitivity analyses, almost all cases reveal ABPM as a cost-saving approach compared to CBPM, with cost savings reaching up to $228 PPPY in the highest hypertension treatment cost model. Regression results reveal that ABPM was cost-saving compared to CBPM if ABPM annual payment rates are $100 or less and annual hypertension treatment costs are ⩾$300.

Conclusion: The potential cost-savings of using ABPM instead of CBPM found in our simulation model underscores the need for confirmatory research using real-world data to support increased use of ABPM as the standard diagnostic approach for hypertension.

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来源期刊
Health Services Insights
Health Services Insights HEALTH CARE SCIENCES & SERVICES-
CiteScore
3.60
自引率
0.00%
发文量
47
审稿时长
8 weeks
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