PMID- 34966712
OWN - NLM
STAT- MEDLINE
DCOM- 20220401
LR  - 20220531
IS  - 2296-2565 (Electronic)
IS  - 2296-2565 (Linking)
VI  - 9
DP  - 2021
TI  - Cost-Utility Analysis of the Integrated Care Models for the Management of 
      Hypertension Patients: A Quasi-Experiment in Southwest Rural China.
PG  - 727829
LID - 10.3389/fpubh.2021.727829 [doi]
LID - 727829
AB  - Background: Hypertension has become the second-leading risk factor for death 
      worldwide. However, the fragmented three-level "county-township-village" medical 
      and healthcare system in rural China cannot provide continuous, coordinated, and 
      comprehensive health care for patients with hypertension, as a result of which 
      rural China has a low rate of hypertension control. This study aimed to explore 
      the costs and benefits of an integrated care model using three intervention 
      modes-multidisciplinary teams (MDT), multi-institutional pathway (MIP), and 
      system global budget and performance-based payments (SGB-P4P)-for hypertension 
      management in rural China. Methods: A Markov model with 1-year per cycle was 
      adopted to simulate the lifetime medical costs and quality-adjusted life-years 
      (QALYs) for patients. The interventions included Option 1 (MDT + MIP), Option 2 
      (MDT + MIP + SGB-P4P), and the Usual practice (usual care). We used the 
      incremental cost-effectiveness ratio (ICER), net monetary benefit (NMB), and net 
      health benefit (NHB) to make economic decisions and a 5% discount rate. One-way 
      and probability sensitivity analyses were performed to test model robustness. 
      Data on the blood pressure control rate, transition probability, utility, annual 
      treatment costs, and project costs were from the community intervention trial 
      (CMB-OC) project. Results: Compared with the Usual practice, Option 1 yielded an 
      additional 0.068 QALYs and an additional cost of $229.99, resulting in an ICER of 
      $3,373.75/QALY, the NMB was -$120.97, and the NHB was -0.076 QALYs. Compared with 
      the Usual practice, Option 2 yielded an additional 0.545 QALYs, and the cost 
      decreased by $2,007.31, yielding an ICER of -$3,680.72/QALY. The NMB was 
      $2,879.42, and the NHB was 1.801 QALYs. Compared with Option 1, Option 2 yielded 
      an additional 0.477 QALYs, and the cost decreased by $2,237.30, so the ICER was 
      -$4,688.50/QALY, the NMB was $3,000.40, and the NHB was 1.876 QALYs. The one-way 
      sensitivity analysis showed that the most sensitive factors in the model were 
      treatment cost of ESRD, human cost, and discount rate. The probability 
      sensitivity analysis showed that when willingness to pay was $1,599.16/QALY, the 
      cost-effectiveness probability of Option 1, Option 2, and the Usual practice was 
      0.008, 0.813, and 0.179, respectively. Conclusions: The integrated care model 
      with performance-based prepaid payments was the most beneficial intervention, 
      whereas the general integrated care model (MDT + MIP) was not cost-effective. The 
      integrated care model (MDT + MIP + SGB-P4P) was suggested for use in the 
      community management of hypertension in rural China as a continuous, 
      patient-centered care system to improve the efficiency of hypertension 
      management.
CI  - Copyright (c) 2021 Ke, Zhang and Tang.
FAU - Ke, Xiatong
AU  - Ke X
AD  - School of International Pharmaceutical Business, China Pharmaceutical University, 
      Nanjing, China.
AD  - Center for Pharmacoeconomics and Outcomes Research of China Pharmaceutical 
      University, Nanjing, China.
FAU - Zhang, Liang
AU  - Zhang L
AD  - School of Medical and Health Management, Tongji Medical College of Huazhong 
      University of Science and Technology, Wuhan, China.
AD  - Research Center for Rural Health Services, Hubei Province Key Research Institute 
      of Humanities and Social Sciences, Wuhan, China.
FAU - Tang, Wenxi
AU  - Tang W
AD  - School of International Pharmaceutical Business, China Pharmaceutical University, 
      Nanjing, China.
AD  - Center for Pharmacoeconomics and Outcomes Research of China Pharmaceutical 
      University, Nanjing, China.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20211213
PL  - Switzerland
TA  - Front Public Health
JT  - Frontiers in public health
JID - 101616579
SB  - IM
MH  - Cost-Benefit Analysis
MH  - *Delivery of Health Care, Integrated
MH  - Humans
MH  - *Hypertension/therapy
MH  - Quality-Adjusted Life Years
PMC - PMC8710505
OTO - NOTNLM
OT  - Markov model
OT  - cost-benefit analysis
OT  - hypertension management
OT  - integrated care
OT  - rural China
COIS- The authors declare that the research was conducted in the absence of any 
      commercial or financial relationships that could be construed as a potential 
      conflict of interest.
EDAT- 2021/12/31 06:00
MHDA- 2022/04/02 06:00
PMCR- 2021/12/13
CRDT- 2021/12/30 05:42
PHST- 2021/06/19 00:00 [received]
PHST- 2021/11/10 00:00 [accepted]
PHST- 2021/12/30 05:42 [entrez]
PHST- 2021/12/31 06:00 [pubmed]
PHST- 2022/04/02 06:00 [medline]
PHST- 2021/12/13 00:00 [pmc-release]
AID - 10.3389/fpubh.2021.727829 [doi]
PST - epublish
SO  - Front Public Health. 2021 Dec 13;9:727829. doi: 10.3389/fpubh.2021.727829. 
      eCollection 2021.