Cost-Utility Analysis of the Integrated Care Models for the Management of Hypertension Patients: A Quasi-Experiment in Southwest Rural China

Abstract

Background: Hypertension has become the second-leading risk factor for death worldwide. However, the fragmented three-level “county–township–village” medical and healthcare system in rural China cannot provide continuous, coordinated, and comprehensive health care for patients with hypertension, as a result of which rural China has a low rate of hypertension control. This study aimed to explore the costs and benefits of an integrated care model using three intervention modes—multidisciplinary teams (MDT), multi-institutional pathway (MIP), and system global budget and performance-based payments (SGB-P4P)—for hypertension management in rural China.Methods: A Markov model with 1-year per cycle was adopted to simulate the lifetime medical costs and quality-adjusted life-years (QALYs) for patients. The interventions included Option 1 (MDT + MIP), Option 2 (MDT + MIP + SGB–P4P), and the Usual practice (usual care). We used the incremental cost-effectiveness ratio (ICER), net monetary benefit (NMB), and net health benefit (NHB) to make economic decisions and a 5% discount rate. One-way and probability sensitivity analyses were performed to test model robustness. Data on the blood pressure control rate, transition probability, utility, annual treatment costs, and project costs were from the community intervention trial (CMB-OC) project.Results: Compared with the Usual practice, Option 1 yielded an additional 0.068 QALYs and an additional cost of $229.99, resulting in an ICER of $3,373.75/QALY, the NMB was –$120.97, and the NHB was −0.076 QALYs. Compared with the Usual practice, Option 2 yielded an additional 0.545 QALYs, and the cost decreased by $2,007.31, yielding an ICER of –$3,680.72/QALY. The NMB was $2,879.42, and the NHB was 1.801 QALYs. Compared with Option 1, Option 2 yielded an additional 0.477 QALYs, and the cost decreased by $2,237.30, so the ICER was –$4,688.50/QALY, the NMB was $3,000.40, and the NHB was 1.876 QALYs. The one-way sensitivity analysis showed that the most sensitive factors in the model were treatment cost of ESRD, human cost, and discount rate. The probability sensitivity analysis showed that when willingness to pay was $1,599.16/QALY, the cost-effectiveness probability of Option 1, Option 2, and the Usual practice was 0.008, 0.813, and 0.179, respectively.Conclusions: The integrated care model with performance-based prepaid payments was the most beneficial intervention, whereas the general integrated care model (MDT + MIP) was not cost-effective. The integrated care model (MDT + MIP + SGB-P4P) was suggested for use in the community management of hypertension in rural China as a continuous, patient-centered care system to improve the efficiency of hypertension management.

Medical effectiveness and cost-effectiveness of a multidisciplinary team-based approach to the management of community residents with hypertension: an analysis of an interventional follow-up study

“…An MDT-based approach might increase the costs for follow-up and medication despite its potential bene cial health effects to community residents. A previous interventional follow-up study showed that an integrated performance-based prepaid care mode might be feasible and bene cial, but it was of low cost-effectiveness [19]. Therefore, we assessed the Quality-Adjusted Life Years (QALYs), incremental costs, and incremental cost-effectiveness ratios (ICERs) of community residents to identify an optimal and economical option for community residents regarding the management of hypertension, diabetes, dyslipidemia, and other cardiovascular diseases.…”

Evolutionary Trends in Integrated Care in 2000–2020 in China: A Scientometric Review Using CiteSpace

“…In recent years, Chinese scholars have begun to focus on the effectiveness and efficiency of integrated care [1]. For example, the KE (2021) study explored the costs and benefits of an integrated care model using multidisciplinary team (MDT), multi-institutional pathways (MIP), and system global budget and performance-based payment (SGB-P4P) for chronic disease management in China [2].…”