Cost-effectiveness analysis of different hypertension management strategies in a community setting

Self-management schemes and mobile apps can be used for the management of hypertension in the community, but the most appropriate patient population is unknown. To explore whether the Chinese Health Literacy Scale (CHLSH) can be used to screen for appropriate patients with hypertension for self-management and to evaluate the clinical effectiveness and health economic evaluation of three hypertension management schemes. This was a prospective study performed from March 2017 to July 2017 in consecutive patients with primary hypertension and of 50-80 years of age from the Jinyang community, Wuhou District, Chengdu. The CHLSH was completed and the patients were classified into the high (n = 283) and low (n = 315) health literacy groups. The patients were randomly divided into the self-management, traditional management, and mobile app management groups. The high-health literacy group was selected to construct the cost-effectiveness decision tree model. Blood pressure control rate and the quality-adjusted life years (QALYs) were determined. At the end of follow-up, the success rate of self-management was 83.4%. The costs for 6 months of treatment for each patient with hypertension in the self-management, traditional management, and mobile app groups were 1266, 1751, and 1856 yuan, respectively. The costs required for obtaining 1 QALY when managing for 6 months were: 30,869 yuan for self-management; 48,628 yuan for traditional management; and 43,199 yuan for the mobile app. The CHLSH can be used as a tool for screening patients with hypertension for self-management. The cost-effectiveness of self-management was optimal.