系统血压测量误差对密集血压目标的成本效益的影响
Karen C Smith1, Thomas A Gaziano2, Alvin I Mushlin3
1Department of Orthopedic Surgery, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts (K.C.S.).
Annals of internal medicine
|August 18, 2025
概括
对于高心血管风险患者来说,低于120mmHg的密集缩血压目标是具有成本效益的,即使有测量误差. 然而,如果血压测量误差很高,可能更喜欢一个不那么密集的目标.
科学领域:
- 心血管医学 心血管医学
- 卫生经济学 卫生经济学
- 临床试验分析
背景情况:
- 临床试验分析表明,对于高心血管疾病 (CVD) 风险患者来说,密集的系统血压 (SBP) 目标 (<120 mm Hg) 是具有成本效益的.
- 目前的指导方针建议目标<130 mm Hg,考虑到例行实践中测量血压的潜在错误.
研究的目的:
- 评估测量误差对密集的SBP目标成本效益的影响.
- 为了比较SBP目标的<120 mm Hg,<130 mm Hg,和<140 mm Hg.
主要方法:
- 开发了一个微模拟模型来模拟不同的SBP测量误差.
- 我们利用了来自缩血压干预试验 (SPRINT) 和已发表文献的数据.
- 从医疗保健部门的角度来看,该分析考虑了终身时间视野.
主要成果:
- 在研究级测量 (0 mm Hg误差) 的情况下,<120 mm Hg与<130 mm Hg的增量成本效益比 (ICER) 为每QALY24,400美元.
- 在平均测量误差 (7.3 mm Hg) 的情况下,ICER增加到每QALY 42.000美元.
- 在高误差场景 (≥14.6 mm Hg) 中,ICER每QALY超过10万美元,特别是在较低SBP或药物不实用的情况下,心血管疾病风险增加.
结论:
- 对于高心血管风险的SPRINT合格患者来说,静脉血压目标值<120毫米升似乎具有成本效益,即使具有典型的测量误差.
- 在较低SBP的实质性测量误差和心血管疾病风险增加的情况下,Hg<130mm的目标可能会变得更具成本效益.
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