基于倾向指数匹配法的两种社区常用二联降压药物组合的成本-效果分析  

Propensity-score-matching-based Cost-effectiveness Analysis of Two Combinations of Two Antihypertensive Agents Commonly Used in the Community

作　　者：冯芮华[1] 王小万[1] 王增武 李建[1] 王馨 崔月颖[1] 

机构地区：[1]中国医学科学院医学信息研究所,北京市100020 [2]中国医学科学院阜外医院国家心血管病中心,北京市102308

出　　处：《中国全科医学》2017年第36期4523-4528,共6页Chinese General Practice

基　　金：卫生行业科研专项项目(200902001);中央级公益性科研院所基本科研业务费(2016ZX330017)

摘　　要：目的根据大样本、多中心临床观察性数据,基于倾向指数匹配法评价两种社区常用二联降压药物组合的成本-效果。方法 2011年9月—2012年10月,选取国家卫生与计划生育委员会公益性卫生行业科研专项资料中应用二联降压药物治疗的资料齐全且规范化管理满1年的高血压患者2 338例,分别是钙拮抗剂+血管紧张素转化酶抑制剂(ACEI)(1 559例)和钙拮抗剂+血管紧张素Ⅱ受体拮抗剂(ARB)(779例)。以患者治疗方案为因变量,以协变量(所有影响抗高血压药物治疗效果的变量)为自变量建立Logistic回归模型,并计算高血压患者的倾向指数,以倾向指数为距离函数进行样本卡钳匹配,然后利用匹配后的样本进行成本-效果分析。结果匹配后协变量在两组之间的分布达到很好的均衡;与钙拮抗剂+ARB[1 590.4(1 455.9)元]相比,钙拮抗剂+ACEI[569.4(1 513.7)元]的年人均成本较低(P<0.05);与钙拮抗剂+ACEI[(10.8±9.4)%]相比,钙拮抗剂+ARB[(12.1±9.8)%]的平均舒张压下降率较高(P<0.05);钙拮抗剂+ACEI与钙拮抗剂+ARB收缩压下降率和血压控制率比较,差异无统计学意义(P>0.05)。无论是收缩压、舒张压下降率,还是血压控制率,钙拮抗剂+ACEI(45.2、52.7、6.9)的成本-效果较钙拮抗剂+ARB(116.1、131.4、18.3)下降2倍左右。结论采用倾向指数匹配法能有效降低混杂偏倚,钙拮抗剂+ACEI具有较好的成本-效果。Objective To evaluate the cost-effectiveness of two combinations of two antihypertensive agents commonly used in the community based on propensity score matching method and large-scale,multicenter clinical observational data. Methods During September 2011 to October 2012, 2 338 patients with hypertension who were treated with two antihypertensive agents and had complete clinical records and standardized management were selected from the data captured from the Research Special Fund for Public Welfare Industry of Health,the National Health and Family Planning Commission. There were 1 559 cases receiving calcium antagonist（ Ca） ＋ angiotensin-converting enzyme inhibitor（ ACEI） and 779 cases receiving Ca ＋ angiotensin Ⅱ receptor antagonists（ ARB）. A Logistic regression model was created based on the treatment regimen as a dependent variable and the covariant（ all variables affecting the therapeutic efficacy of antihypertensive agents） as an independent variable,and the propensity score was calculated. The propensity score was used as a distance function for caliper matching,and the propensity-score-matched samples were subjected to cost-effectiveness analysis. Results The distribution of the propensity-score-matched covariates was in good equilibrium between the patients receiving Ca ＋ ACEI and Ca ＋ ARB.The annual per capita cost [569. 4（ 1 513. 7） Yuan ]was significantly lower in patients receiving Ca ＋ ACEI than in those receiving Ca ＋ ARB [1 590. 4（ 1 455. 9） Yuan]（ P 〈 0. 05）,and the mean reduction rate of diastolic blood pressure [（ 12. 1± 9. 8） % ]was significantly higher in the patients receiving Ca ＋ ARB than in those receiving Ca ＋ ACEI [（ 10. 8 ± 9. 4） % ]（ P 〈 0. 05）. However,no significant difference was seen in the reduction rate of systolic blood pressure or blood pressure control rate between the patients receiving Ca ＋ ACEI and Ca ＋ ARB（ P 〉0. 05）. In addition,the cost-effectiveness of Ca ＋ACEI was reduced by more than half rel

关 键 词：高血压 社区卫生服务 钙拮抗剂 血管紧张素转化酶抑制剂 血管紧张素Ⅱ受体拮抗剂 成本及成本分析 成本-效果分析 

分 类 号：R544.1[医药卫生—心血管疾病]