【摘要】 目的:分析国家基本公共卫生服务中高血压健康管理的成本效果，为进一步开展该项工作提供决策依据。方法:构建决策树-马尔可夫模型，模拟10万名高血压患者在纳入或不纳入国家基本公共卫生服务高血压健康管理情况下的转归。结合高血压患者血压变化值和心脑血管疾病相对风险值，对高血压患者纳入国家基本公共卫生服务高血压健康管理进行成本效果分析。结果:相比不纳入国家基本公共卫生服务高血压健康管理，10万名高血压患者纳入管理会减少8725名高血压患者死亡，减少3485例心脑血管事件的发生，增量成本效果比(incremental cost-effectiveness ratio, ICER)为8586.92元/质量调整寿命年(quality-adjusted life years, QALYs),ICER小于1倍人均国内生产总值(GDP)。相比不纳入管理，纳入管理的ICER从低到高，分别为35-59岁男性高血压患者、35-59岁女性高血压患者、≥60岁女性高血压患者、≥60岁男性高血压患者，ICER分别为8039.64、8125.72、8683.76、10629.96元/QALYs。对模型结果进行敏感性分析发现，相关心脑血管疾病的治疗费用、国家基本公共卫生服务高血压健康管理干预成本以及脑卒中相对风险对ICER的影响较大。结论:将高血压患者纳入国家基本公共卫生服务高血压健康管理具有很好的成本效果，能有效降低高血压患者心脑血管事件的发生率和死亡率，提高患者的生命质量。更多还原

【Abstract】 Objective: To analyze the cost-effectiveness of hypertension program of the National Essential Public Health Services(EPHS) in China, and to provide further decision-making foundation. Methods: Constructed a decision tree-Markov model to calculate the outcome of 100000 hypothetical hypertensive patients under EPHS or not under EPHS. Based on the difference of blood pressure and relative risk of cardiovascular disease, cost-effectiveness was conducted to analyze the inclusion of EPHS. Results: In a cohort analysis of 100000 hypertensive patients, comparing to those are not under EPHS, people under EPHS would reduce 8725 deaths and 3485 cardiovascular events. The incremental cost-effectiveness ratio(ICER) was ￥8586.92 per quality-adjusted life years(QALYs) and ICER was less than 1 times gross domestic product(GDP). Compared with people who are not under EHPS, ICER from low to high were ￥ 8039.64, 8125.72, 8683.76 and 10629.96 per QALYs for male patients aged 35-59, female patients aged 35-59, female patients aged more than 60 years old, and male patients aged more than 60 years old. Sensitivity analysis revealed that treatment cost of cardiovascular diseases, intervention cost of EPHS and relative risk of Stroke had a great impact on the ICER. Conclusion: EPHS is cost-effective and can decrease the incidence of cardiovascular disease and mortality in hypertensive patients, while improving patient’s quality of life.更多还原