Efficacy Evaluation And Cost-Effective Analysis Of A Rural Community Based Hypertension Intervention Program

Objectives To evaluate the effectiveness of a government sponsored(free of charge for patients) standardized anti-hypertensive medicine intervention in a township clinic among patients with high blood pressure in rural community.Methods The effectiveness of free standardized anti-hypertensive medicine program was evaluated through analyzing the data collected from 1589 patients with primary hypertension enrolled in an anti-hypertensive medicine intervention system of a township clinic from July 2009 to July 2015. The patients' general health, SF-36 quality of life,relevant knowledge on hypertension, attitude and behavior were surveyed upon their consent. A total of 956 patients responded to the survey among which 656 received free standardized anti-hypertensive medicine management and 300 received routine management. Through comparing and analyzing the above data, we evaluated the effectiveness of two intervention methods in blood pressure control rate, mean blood pressure level, quality of life as well as patients' knowledge on hypertension, attitude and behavior. The study also evaluated the economic benefit of the free standardized antihypertensive medicine intervention by comparing the cost of hypertension related hospitalization from 2011 to 2015 as well as the cost of free standardized anti-hypertensive medicine program in the township where free standardized anti-hypertensive medicine intervention was implemented with the cost of hypertension related hospitalization in neighboring townships where free standardized anti-hypertensive medicine intervention was not implemented during the same period. The cost of hypertension related hospitalization was obtained through the reimbursement system of NCMS(New Rural Cooperative Medical System).Results 1 In the free standardized anti-hypertensive medicine group, the 6 year accumulative blood pressure control rate reached 55.38%. On average the SBP and DBP decreased(25.05 ± 20.47) mm Hg and(13.58 ± 12.15) mm Hg respectively. The longer intervention time correlates with better blood pressure control rates. The OR value and95%CI are 1.015 and(1.007~1.023) respectively. The intervention length is a protective factor for hypertension control rate. 2 Among the 956 hypertension patients who responded to the survey, 656 received free standardized anti-hypertensive medicine intervention while 300 received routine intervention. The total control rate is 35.4%. Compared with the group that received routine intervention, the group that received free standardized anti-hypertensive medicine intervention had higher blood pressure control rate for(38.7%, P<0.05), lower SBP(2.93 mm Hg, P<0.05), higher correct answer rate on hypertension relevant knowledge and attitude survey(P<0.05)and higher behavior change rate(P<0.05). 3 The average annual cost per patient for free standardized antihypertensive medicine intervention is 68.05 yuan. The ratio of average cost per patient and the cost-benefit of DBP and SBP are 2.71:1 and 5.01:1 respectively, indicating for every 1mm Hg decrease in SBP(0.5 mm Hg decrease in DBP), the township clinic will need to spend 2.72 yuan on free standardized anti-hypertensive medicine intervention and for everyone 1 mm Hg decrease in DBP(1.8mm Hg decease in SBP), the township clinic will need to spend 5.01 yuan on free standardized anti-hypertensive medicine intervention. The total savings on cardio-vascular disease related cost in the past five years since the implementation of free standardized anti-hypertensive medicine management is 1,525,907 yuan, of which 762,954 yuan was saved for the NCMS. The cost-benefit of the free standardized anti-hypertensive medicine management program is 2.82:1, meaning for every yuan the township clinic spends on the anti-hypertensive medicine, there will be 2.82 yuan medical cost saved.Conclusions 1 The free standardized anti-hypertensive medicine intervention is effective in controlling patient's high blood pressure. The longer intervention correlated with higher blood pressure control rate. 2 Compared with routine standardized intervention, free standardized anti-hypertensive medicine intervention has higher blood pressure control rate and is more effective in educating patients' with relevant hypertension knowledge and changing patients' attitude and behavior. 3 Free standardized anti-hypertensive medicine program is cost-effective and can save medical cost, thereby reducing financial burdens to society.