Background
Methods
Ashkelon Hypertension Detection and Control Program (AHDC Program)
Israel Blood Pressure Control (IBPC) program
Costs of program
Incidence and mortality reductions
Age/Sex | Hypertension (%) | AMI (20 y %risk) | CVA (rate/1000) | ESRD (rate/100,000) |
---|---|---|---|---|
25–44 M/F | 3.8/3.2 | 5–22 | 1.14 | NA |
45–54 M/F | 14.7/13.9 | 23–32 | 2.28 | 31.9/16.7 |
55–64 M/F | 34.5/27.8 | 33–50 | 5.11 | 77.8/44.6 |
65< | 50< | 50< | 9.86 | 148.7/88.5 |
AMI & UAP
CVA
ESRD
PVD
Impact on treatment costs
AMI & UAP: AMI & UAP
CVA
ESRD
PVD
Disability Adjusted Life Year (DALYs) saved
Cost per DALYs ratio
Results
INCIDENCE Without Program | INCIDENCE With Program | Decrease | MORTALTY Without Program | MORTALITY With Program | Decrease | |
---|---|---|---|---|---|---|
AMI | 98,182 | 89,433 | 8,749 | 6,094 | 5,551 | 543 |
UAP | 38,939 | 32,174 | 6,765 | 696 | 552 | 145 |
CVA | 39,217 | 31,143 | 8,074 | 5,412 | 4,298 | 1,114 |
ESRD | 9,277 | 6,961 | 2,316 | 1,763 | 1,323 | 440 |
PVD | 38,194 | 30,060 | 8,134 | NA | NA | NA |
TOTAL | NA | NA | NA | 13,965 | 11,723 | 2,242 |
Mortality | Morbidity | Total | ||
---|---|---|---|---|
Life Years
|
DALY
|
DALY
|
DALY
| |
AMI | 8,925 | 4,611 | 159 | 4,770 |
UAP | 2,401 | 1,174 | 330 | 1,504 |
CVA | 16,904 | 9,091 | 10,812 | 19,903 |
ESRD | 6,888 | 3,850 | 783 | 4,633 |
PVD | - | - | 1,558 | 1,558 |
TOTAL | 35,117 | 18,726 | 13,643 | 32,369 |
Training Staff | $29,679,980 |
---|---|
Training Hypertensive cases |
$70,037,048
|
Maintenance Visits |
$66,797,601
|
Extra Drug Costs |
$186,182,588
|
TOTAL PROGRAM COSTS
|
$352,697,217
|
Reduced Treatment |
$444,382,484
|
Reduced drug Use |
$93,270,706
|
TOTAL SAVINGS
|
$537,653,190
|
NET PROGRAM SAVINGS
|
$184,955,973
|
Sensitivity analyses
Discussion
Conclusion
Appendix
Appendix I: Key Economic Variables | Reference/Data Source | |
---|---|---|
ECONOMIC
| ||
Annual Discount Rate | 3% | 27 |
Exchange Rate: Shekels to USD (2005) | 4.35 | 12 |
Per capita GDP (USD 2003) | $16,497 | 12 |
Training Staff
| ||
Number of Clinics in Israel | 3000 | MOH Statistical Dept. |
Staff per clinic receiving training | 2 | Ashkelon Project |
Full Days Training in initial year | 2 | Ashkelon Project |
Days training in subsequent years | 1 | Ashkelon Project |
Cost per ticipant-day of training course | $100 | Ashkelon Project |
Tele-management & Operational costs per patient. | $60 | Ashkelon Project |
Nurse/GP guidance per patient in first year of program | $230 | Ashkelon Project |
Unit Care Costs
| ||
Ambulatory visit to Nurse or Nutritionist | $7.83 | 15 mins visit & 5 mins secretarial time |
Ambulatory GP visit | $11.37 | 15 mins GP & 5 mins secretarial time |
Cost of OPV | $99.14 | 25% of general hospital cost (30) |
General Hospital Cost per day | $397 | 30 |
ICU cost per day | $1,586 | estimated as four times general per diem cost (30) |
Rehabilitation Hospital Cost per day | $238.85 | 30 |
Home Physiotherapy Visit | $38.53 | 30 |
Devices and Procedure costs
| ||
Stent | $202 | Barzelai Hospital Accounts Dept. |
Cypher | $2,989 | Barzelai Hospital Accounts Dept. |
Diagnostic Catheterisation | $2,464 | 30 |
Restenosis | $9,701 | 30, includes 1 day in ICU & 3 days in cardiac ward |
Average cost of Catheterisation with Stent or cypher | $6,925 | 30 |
CABG operation | $12,740 | 30 |
TPA | $1,800 | 30 estimated as four times general per diem cost |
PRS Streptokinaise | $81 | 31 |
Kidney Transplant Cost | $39,132 | 30 |
Haemodialysis cost | $313 | 30 |
Peritonea dialysis cost | $136 | 30 |
% receiving haemodialysis | 88.8% | 20 |
Average annual Dialysis Cost | $46,041 | 30 |
Drug Costs
| ||
Post-MI or stroke drugs per day per patient- Males | $1.92 | 14 |
Post-MI or stroke drugs per day per patient- Females | $1.79 | 14 |
Post-UAP drugs per day per patient- Males | $1.92 | 14 |
Post-UAP drugs per day per patient- Females | $1.79 | 14 |
Correct preventive medication per day | $0.92 | 14, Ace inhibitor, Aspirin & Statin |
Inadequate preventive medication per day | $0.31 | 14, Assumed only 1 correct drug taken |
Appendix II: Key Epidemiologic Variables | Reference/Data Source | |
---|---|---|
EPIDEMIOLOGIC
| ||
Male life expectancy at age 60 (years) | 20.9 | 12 |
Female life expectancy at age 60 (years) | 23.4 | 12 |
Healthy Adjusted Life expectancy at age 60 males | 16.8 | 24 |
Healthy Adjusted Life expectancy at age 60 females | 18.2 | 24 |
Hypertension
| ||
% hypertensive cases, Males 25–44 | 3.8% | 12 |
% hypertensive cases, Males 45–54 | 14.7% | 12 |
% hypertensive cases, Males 55–64 | 27.8% | 12 |
% hypertensive cases, Females 25–44 | 3.2% | 12 |
% hypertensive cases, Females 45–54 | 13.9% | 12 |
% hypertensive cases, Females 55–64 | 34.5% | 12 |
% of persons treated successfully in program | 50% | 9,10,13 |
Acute MI
| ||
Annual Incidence | 8940 | 14 |
% AMI in Males | 77.0% | 14 |
20 year MI risk at age 25 | 5.0% | 11 |
20 year MI risk at age 30 | 7.5% | 11 |
20 year MI risk at age 35 | 10.0% | 11 |
20 year MI risk at age 40 | 16.0% | 11 |
20 year MI risk at age 45 | 22.0% | 11 |
20 year MI risk at age 50 | 27.0% | 11 |
20 year MI risk at age 55 | 32.0% | 11 |
20 year MI risk at age 60 | 41.0% | 11 |
20 year MI risk at age 65 | 50.0% | 11 |
Annual increase in MI risk over 20 years | 1.0% | Assumed |
Decrease in risk of MI in persons successfully treated | 16.0% | 9,10,15–17 |
Health Status Valuation of MI patient | 0.61 | 25 |
Years in decreased health state. | 0.06 | 26 |
Unstable Angina Pectoris
| ||
Annual Incidence | 3354 | 14 |
% UAP in males | 73.9% | 14 |
Decrease in risk of UAP in persons succesfully treated | 16.0% | 9,10,15–17 |
Health Status Valuation of UAP patient | 0.91 | 25 |
Years in decreased health state. | 1.00 | 26 |
Stroke
| ||
Mean age of stroke | 73.2 | 19 |
% strokes in males | 58.2% | 19 |
Relative Risk of Stroke in Hypertensive cases | 1.7 | 19 |
Stroke rate per 1000 aged 45–55 | 1.14 | 19 |
Stroke rate per 1000 aged 55–64 | 2.28 | 19 |
Stroke rate per 1000 aged 65–74 | 5.11 | 19 |
Stroke rate per 1000 aged 75–84 | 9.86 | 19 |
Decrease in Stroke risk in persons successfully treated | 41.2% | 19 |
Health Status Valuation of first ever stroke patient | 0.78 | 25 |
Years in decreased health state. | 7.80 | 26 |
Chronic Renal Failure
| ||
ESRD incidence rates per 100,000 Males 45–54 | 31.9 | 19 |
ESRD incidence rates per 100,000 Males 55–64 | 77.8 | 19 |
ESRD incidence rates per 100,000 Males 65–74 | 148.7 | 19 |
ESRD incidence rates per 100,000 Males 75+ | 174.2 | 19 |
ESRD incidence rates per 100,000 Females 45–54 | 16.7 | 19 |
ESRD incidence rates per 100,000 Females 55–64 | 44.6 | 19 |
ESRD incidence rates per 100,000 Females 65–74 | 88.5 | 19 |
ESRD incidence rates per 100,000 Females 75+ | 71.9 | 19 |
Decrease in ESRD risk in persons successfully treated | 49.9% | 10 |
Health Status Valuation of ESRD | 0.904 | 28 |
PVD
| ||
PVD incidence per 1000 male hypertensive cases | 6.20 | 23 |
PVD incidence per 1000 female hypertensive cases | 3.65 | 23 |
PVD Relative Risk in Hypertensive to Normotensive cases | 2.31 | 23 |
PVD Relative Risk in Hypertensive to controlled cases | 1.40 | 23 |
Attainable risk reduction Hypertensive to Normotensive cases | 56.8% | 23 |
Attainable risk reduction Hypertensive to Controlled cases | 28.4% | 23 |
% treated who become controlled cases | 50% | 9,10 |
% treated who become normotensive cases | 50% | 9,10 |
Appendix III: Key Utilization variables. | Reference/Data Source | ||
---|---|---|---|
UTILIZATION
| Both Genders | ||
Hypertension Treatment
| |||
% of persons transferred to NPC of hypertension | 50% | 9 | |
Existing ambulatory visits in first year for hypertension | 1.0 | Barzelai Hospital | |
Existing annual maintenance visits for hypertension | 0.5 | Barzelai Hospital | |
Annual maintenance visits in program | 2.0 | 9 | |
Average time of visit (minutes) | 15 | 9 | |
Males | Females | ||
AMI Treatment
| |||
GP visits in three years prior to AMI | 10 | 10 | Assumption |
% AMI that are catheterised | 72% | 59% | 14 |
% AMI getting stent/baloon (primary PCI) | 19% | 14% | 14 |
% AMI getting stent (late PCI) | 38% | 32% | 14 |
% AMI getting CABG | 8% | 4% | 14 |
% AMI being discharged after catheterisation | 7% | 9% | 14 |
% AMI being discharged with no catheterisation | 5% | 22% | 14 |
% AMI with Thrombolysis | 23% | 19% | 14 |
% AMI rehospitalised for cardiac reasons in month | 15.4% | 15.7% | 14 |
% ratio of cyphers to all cypher-stent usage | 40.0% | 40.0% | MOH Medical Technology Assesment Dept. |