Hypertension Clinical Trial
Official title:
In-depth Study of the Cost-effectiveness of the Risk Assessment and Management Programme for Hypertension (RAMP-HT) for Patients With Uncontrolled Hypertension in Primary Care in Hong Kong
Hypertension (HT) is an important risk factor for stroke, coronary heart disease (CHD), heart
failure and renal diseases, and the leading risk factor of global disease burden. A multitude
of interventions have proven efficacy in lowering blood pressure and reducing long term HT
complications, including pharmacologic treatment, DASH diet (Dietary Approaches to Stop
Hypertension), exercise, weight reduction, smoking cessation, alcohol moderation and
self-monitoring of blood pressure.
Objectives:
To evaluate long-term effectiveness and cost-effectiveness of
Risk-Assessment-and-Management-Programme-for-Hypertension (RAMP-HT), a multi-disciplinary
structured service to enhance quality of hypertension care in primary care compared to usual
care
Hypotheses:
1. RAMP-HT is effective in reducing HT complications, based on previous results showing
RAMP-HT was effective in improving patients' blood pressure
2. RAMP-HT is cost-effective
Design and Subjects:
Retrospective study of 5-year longitudinal data on matched cohorts of public primary care
patients with uncontrolled HT under RAMP-HT and usual care will be conducted to evaluate
long-term effectiveness and direct medical costs. Results from the long-term effectiveness
and costing analyses will be applied to Markov modeling to determine the life time
cost-effectiveness of RAMP-HT.
Main outcome measures:
1. 5-year incidence of cardiovascular complications
2. Direct medical costs of RAMP-HT and usual care HT patients
3. Incremental cost-effectiveness ratio (ICER) of cost per quality-adjusted life year
(QALY) gained by RAMP-HT compared to usual care
Data analysis:
Cox regression will be performed to estimate the effect of RAMP-HT on the development of HT
complication adjusted for baseline covariates. Descriptive statistics will be used to
calculate costs of RAMP-HT and annual direct medical costs for HT patients. Markov modeling
will be used to simulate 2 patient cohorts (RAMP-HT versus usual care) to estimate the
respective lifetime direct medical costs and QALY gained/person. Cost/QALY of RAMP-HT will be
compared to that of usual care to determine the ICER.
Expected results:
The results can provide evidence on the effectiveness and cost-effectiveness of RAMP-HT for
primary care patients with uncontrolled HT, which can inform health policy and service
planning.
Aim and objectives:
The aim of this study is to evaluate the cost-effectiveness of the RAMP-HT of the HA in
primary care patients with uncontrolled hypertension.
The objectives are to:
1. Evaluate the long term (5-year) effectiveness of RAMP-HT compared to usual care in
reducing cardiovascular complications, end-stage renal disease and all-cause mortalities
in a cohort of primary care patients with uncontrolled hypertension at baseline
2. Estimate the direct medical cost of RAMP-HT and other health services among primary care
HT patients with or without complications
3. Evaluate the cost-effectiveness of RAMP-HT, compared to usual care, in gaining one QALY
in primary care patients with uncontrolled hypertension
Hypotheses:
1. RAMP-HT is more effective in reducing 5-year cardiovascular complications, end stage
renal disease and all-cause mortality among primary care patients with uncontrolled
hypertension compared to usual care
2. The direct medical cost of RAMP-HT patients, for the same disease complication status,
is not higher than that of usual care except for the RAMP-HT cost
3. The direct medical cost of HT patients with one or more complications is higher than
that of HT patients without any complication
4. RAMP-HT is cost-effective compared to usual care, i.e. ICER per QALY gained is below the
threshold value of 1 annual GDP (Gross Domestic Product) per capita of Hong Kong, which
is the benchmark recommended by the World Health Organization
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