基層高血壓患者管理經(jīng)濟(jì)學(xué)評(píng)價(jià)（中英文版）

1概述/1
1.1背景/1
1.2研究目的/2
1.3國(guó)家基本公共衛(wèi)生服務(wù)項(xiàng)目介紹/3
1.3.1基層醫(yī)療衛(wèi)生服務(wù)體系/3
1.3.2國(guó)家基本公共衛(wèi)生服務(wù)/4
1.3.3高血壓患者管理服務(wù)規(guī)范/5
1.3.4國(guó)家基本公共衛(wèi)生服務(wù)項(xiàng)目籌資機(jī)制和高血壓控制/6
1.4概念框架、方法和數(shù)據(jù)來(lái)源/7
1.4.1研究框架及概念/7
1.4.2研究?jī)?nèi)容/7
1.4.3數(shù)據(jù)來(lái)源/12
1.4.4效益、效益成本比率和內(nèi)部收益率計(jì)算/12
1.5本書(shū)結(jié)構(gòu)/13
2高血壓及其影響、健康結(jié)果及經(jīng)濟(jì)學(xué)評(píng)價(jià)/14
2.1引言/14
2.2高血壓與健康影響/16
2.2.1高血壓和心血管疾病/16
2.2.2高血壓及其影響研究的相關(guān)指標(biāo)/17
2.3國(guó)家基本公共衛(wèi)生服務(wù)項(xiàng)目在高血壓患者管理和血壓控制中的作用/19
2.4如何量化高血壓患者的心血管疾病發(fā)病風(fēng)險(xiǎn)/21
2.4.1國(guó)際風(fēng)險(xiǎn)預(yù)測(cè)方程研究/21
2.4.2我國(guó)開(kāi)發(fā)的風(fēng)險(xiǎn)預(yù)測(cè)模型/22
2.5基于高血壓控制評(píng)估健康結(jié)果/23
2.5.1冠心病決策模型及其在本研究中的應(yīng)用/24
2.5.2本研究的馬爾可夫模型和納入疾病/26
2.6衛(wèi)生健康項(xiàng)目的經(jīng)濟(jì)學(xué)評(píng)價(jià)/27
2.6.1基本方法與理論/27
2.6.2成本-效益分析和確定效益的價(jià)值/27
2.6.3國(guó)際上對(duì)社區(qū)高血壓患者干預(yù)的經(jīng)濟(jì)學(xué)評(píng)價(jià)研究/28
2.6.4我國(guó)的研究差距/29
2.7小結(jié)/30
3國(guó)家基本公共衛(wèi)生服務(wù)項(xiàng)目對(duì)高血壓控制的影響/32
3.1概述/32
3.2高血壓患病率、知曉率、治療率和控制率的文獻(xiàn)研究/
（1990年至今）/33
3.2.1文獻(xiàn)檢索策略/33
3.2.2納入排除標(biāo)準(zhǔn)/34
3.2.3文獻(xiàn)分析/34
3.3年齡別高血壓四率分析/39
3.4高血壓控制率的時(shí)間序列分析/43
3.4.1數(shù)據(jù)來(lái)源/43
3.4.2統(tǒng)計(jì)分析/43
3.4.3結(jié)果/43
3.5國(guó)家基本公共衛(wèi)生服務(wù)項(xiàng)目高血壓控制效果的相關(guān)研究結(jié)果/48
3.5.1高血壓管理的統(tǒng)計(jì)分析/48
3.5.2其他研究分析國(guó)家基本公共衛(wèi)生服務(wù)項(xiàng)目的高血壓/
控制情況/
3.6討論/52
3.7局限性分析/54
3.8小結(jié)55
4基于馬爾可夫模型估計(jì)國(guó)家基本公共衛(wèi)生服務(wù)項(xiàng)目
的健康產(chǎn)出/56
4.1項(xiàng)目介紹/56
4.2高血壓患者心血管疾病風(fēng)險(xiǎn)分析/57
4.2.1危險(xiǎn)因素分析/57
4.2.2危險(xiǎn)因素分析結(jié)果/58
4.3方法：馬爾可夫模型研究/59
4.3.1馬爾可夫模型的建立/59
4.3.2目標(biāo)人群/61
4.3.3估計(jì)長(zhǎng)期健康結(jié)果的參數(shù)/64
4.3.4靈敏度分析/67
4.4長(zhǎng)期健康結(jié)果估計(jì)/69
4.4.1兩組心血管疾病進(jìn)展和死亡的長(zhǎng)期趨勢(shì)/69
4.4.2避免心腦血管患者數(shù)和死亡數(shù)的估計(jì)/69
4.5小結(jié)/74
5國(guó)家基本公共衛(wèi)生服務(wù)項(xiàng)目高血壓管理的成本、
效益和投資回報(bào)——基于創(chuàng)新性方法的研究/76
5.1介紹/76
5.2概念框架/77
5.2.1干預(yù)、成本和效益/78
5.2.2目標(biāo)人群結(jié)構(gòu)和估計(jì)假設(shè)/81
5.2.3靈敏度分析/82
5.2.4疾病經(jīng)濟(jì)成本分析（CoI）/82
5.3干預(yù)成本、效益和投資回報(bào)/83
5.3.1國(guó)家基本公共衛(wèi)生服務(wù)項(xiàng)目高血壓管理投入/83
5.3.2發(fā)病和死亡人數(shù)減少的估算/84
5.3.3投資回報(bào)率和效益成本比/86
5.3.4疾病經(jīng)濟(jì)負(fù)擔(dān)分析/86
5.4討論/89
5.5小結(jié)/91
6全書(shū)討論和結(jié)論/92
6.1整體概述/92
6.1.1國(guó)家基本公共衛(wèi)生服務(wù)項(xiàng)目下高血壓控制/92
6.1.2長(zhǎng)期健康結(jié)果估計(jì)/93
6.1.3國(guó)家基本公共衛(wèi)生服務(wù)的成本、效益和回報(bào)分析/94
6.2理論和實(shí)踐價(jià)值/95
6.2.1國(guó)家基本公共衛(wèi)生服務(wù)高血壓患者管理具有較好的
投資回報(bào)/95
6.2.2實(shí)現(xiàn)政策目標(biāo)的可靠路徑/96
6.2.3加強(qiáng)對(duì)年輕患者的高血壓管理/98
6.2.4循證決策將得到強(qiáng)化/98
6.3研究先進(jìn)性與局限性分析/99
6.3.1研究建立了長(zhǎng)期健康結(jié)果的綜合評(píng)價(jià)模型/99
6.3.2構(gòu)建了創(chuàng)新型經(jīng)濟(jì)學(xué)評(píng)價(jià)模型/99
6.3.3本研究的優(yōu)勢(shì)/100
6.3.4研究的局限性分析/100
6.4結(jié)論和政策建議/101
6.5下一步研究建議/102
參考文獻(xiàn)/103
附錄關(guān)鍵內(nèi)容分析過(guò)程與相關(guān)數(shù)據(jù)/119
附錄A第三章主要過(guò)程性數(shù)據(jù)/119
附錄B第四章主要過(guò)程性數(shù)據(jù)/123
附錄C第五章主要過(guò)程性數(shù)據(jù)/134
附錄D性別年齡別高血壓控制狀況和投入產(chǎn)出與成本效益再分析/142
致謝/153
1Recapitulate/155
1.1Background/155
1.2Aimsoftheresearch/157
1.3IntroductiontotheNBPHS/158
1.3.1PrimaryhealthcaresystemofChina/158
1.3.2TheNBPHSprogram/159 
1.3.3Specificationsformanaginghypertensionpatients/160
1.3.4TheNBPHSfundingmechanismandhypertensioncontrol/162
1.4Conceptualframework,methodologiesanddatasources/163
1.4.1Frameworkandconceptualcomponentsoftheresearch/163
1.4.2Componentsofthestudy/164
1.4.3Datasource/169
1.4.4Calculatingthebenefits,benefit-costratioandinternalrateof
return/170
1.5Structureofthebook/170
2Hypertensionanditsconsequences,healthoutcome
quantification,andeconomicevaluations/172
2.1Introduction/172
2.2Hypertensionanditsconsequences/175
2.2.1HypertensionandCVD/175
2.2.2Termsusedinthestudyofhypertensionandits
consequences/175
2.3TheroleoftheNBPHSinthemanagementandcontrolof
hypertension/179
2.4HowtoquantifytheriskofCVDsforhypertension/181
2.4.1Internationalstudiesonriskequations/181
2.4.2RiskpredictionmodelsdevelopedinChina/182
2.5Estimatinghealthoutcomesfromhypertensioncontrol/184
2.5.1IntroductiontotheCHDPmodelanditsapplicationinthis
study/185
2.5.2TheMarkovmodelandscopeofdiseasesforthisstudy/
2.6Economicevaluationofhealthprograms/188
2.6.1Somebasics/188
2.6.2CBAandvaluingthebenefitinCBA/189
2.6.3Internationalevidenceontheeconomicevaluationof
community-basedhypertensioninterventions/190
2.6.4StudygapsinChina/192
2.7Briefsummary/193
3RoleoftheNBPHSonhypertensioncontrol/195
3.1Introduction/195
3.2LiteraturereviewonhypertensionPATCfrom1990tothe
present/197
3.2.1Searchstrategyandselectioncriteria/197
3.2.2Inclusion/exclusioncriteria/197
3.2.3Articlesextracted/198
3.3Age-specificanalysisofPATC/204
3.4Timeseriesanalysisofhypertensioncontrol/209
3.4.1Dataused/209
3.4.2Statisticalanalysis/209
3.4.3Results/210
3.5EvidencefromothersourcesontheroleoftheNBPHS/
3.5.1Statisticalanalysisofhypertensionmanagement/215
3.5.2Evidencefromotherliteratureonhypertensioncontrol
withintheNBPHS/216
3.6Discussion/221
3.7Limitations/223
3.8Briefsummary/224
4HealthoutcomeestimationoftheNBPHS:AMarkov
model/225
4.1Introduction/225
4.2AnalysisofCVDrisksamonghypertensives/226
4.2.1Analysisofriskfactors/226
4.2.2Resultsoftheriskfactoranalysis/228
4.3Method:AMarkovmodel/229
4.3.1Markovmodeldevelopment/229
4.3.2Targetpopulation/231
4.3.3Parametersforestimatinglong-termhealthoutcomes/234
4.3.4Sensitivityanalysis/237
4.4Long-termhealthoutcomeestimations/239
4.4.1Long-termtrendsinCVDdevelopmentanddeathsinthe
twogroups/239
4.4.2EstimatesofCVDsanddeathsaverted/241
4.5Briefsummary/241
5Benefit,costandreturnoninvestmentoftheNBPHS
onhypertensioncontrol:Aninnovativeframework/247
5.1Introduction/247
5.2Conceptualframework/248
5.2.1Interventions,costsandbenefits/249
5.2.2Targetpopulationstructureandassumptions/254
5.2.3Sensitivityanalysis/254
5.2.4Analysisofcostofillness(CoI)/255
5.3Resultsofinterventioncosts,benefitsandreturnon
investment/257
5.3.1Investmentintohypertensionmanagementunderthe
NBPHS/257
5.3.2Mortalityandmorbidityaverted/259
5.3.3Returnoninvestmentandbenefit-costratio/260
5.3.4CoIanalysis/262
5.4Discussion/264
5.5Briefsummary/267
6Discussionandconclusionofthebook/268
6.1Generaldescription/268
6.1.1HypertensioncontrolfromtheNBPHS/268
6.1.2Estimationofthelong-termhealthoutcomesfromthe
NBPHS/269
6.1.3Costs,benefitsandreturnoninvestmentanalysisofthe
NBPHS/270
6.2Contributiontoknowledgeandpolicyimplications/271
6.2.1Agoodreturnoninvestmentforhypertensionmanagement
undertheNBPHS/272
6.2.2Awaytogotoachievepolicygoals/273
6.2.3Hypertensionmanagementofyoungerpatientsshouldbe
strengthened/276
6.2.4Evidence-basedpolicymakingcanbestrengthened/277
6.3Strengthsandlimitations/277
6.3.1Anintegratedevaluationofhealthoutcomesisestablished/277
6.3.2Aninnovativemodelofeconomicevaluationisdeveloped/278
6.3.3Strengthsofthestudy/279
6.3.4Limitations/279
6.4Conclusionsandpolicyrecommendations/280
6.5Howfurtherprogresscanbemade/282
References/283
Appendices/299
AppendixASupplementarymaterialforChapter3/299
AppendixBSupplementarymaterialforChapter4/303
AppendixCSupplementarymaterialforChapter5/314
AppendixDAge-specificanalysisonhypertensioncontroland
re-analysisofreturnoninvestmentandbenefit-cost
ratio/322
Acknowledgements/333