Abstract
Introduction: The Chinese government has established a nationwide community-based chronic disease management program since 2009 with hypertension a vital part of it. Though drugs have been proven effective with hypertensive patients, they bring economic burden as well, especially for those who with elevated blood pressure and are potentially eligible for national programs. When the effectiveness of pharmacotherapy-only interventions remains uncertain on these patients, non-pharmacological interventions have demonstrated non-inferior effectiveness and may have economic advantages. To date, there rarely are evidences on the effectiveness and cost-effectiveness of non-pharmacological treatment in comparison with pharmacological interventions for patients with varying severity of blood pressure. This study aims to propose a study for a network meta-analysis and cost-effectiveness analysis to explore what kind of intervention is potentially effective and cost-effective to four specific patient groups, stage I-III hypertensive patients and patients with elevated blood pressure, and to provide recommendations for hypertensive management to Chinese decision makers.Methods: We will systematically search databases (MEDLINE, PubMed, Cochrane Library, etc.,) for randomized controlled trials and observational studies with qualified study design in recent decade that assess the effectiveness of non-pharmacological, pharmacological, or combined intervention aimed at adult populations who are diagnosed with the above four types of hypertension in China. The effectiveness outcomes will include changes in SBP/DBP, rate of comorbidities, mortality, and health related quality of life. We will use network meta-analysis to compare and rank effectiveness of different interventions. Subgroup analyses and meta-regression analyses will be performed to analyze and explain heterogeneity. The economic outcome will include cost-effectiveness based on simulation results from Markov models. Under study perspective of Chinese health system, life-time direct cost will be included.Discussion: This study aims to compare and rank the effectiveness and cost-effectiveness of pharmacological, non-pharmacological and combined interventions for stage I–III hypertensive patients and those who with elevated blood pressure. Compared to existing studies, this comprehensive synthesis of relevant evidences will influence future practice with better efficiency and generalizability for community-based hypertensive management programs in China. The study might also be valuable for other low- and middle-income countries to find their own solutions.PROSPERO registration number: CRD42020151518
Highlights
The Chinese government has established a nationwide community-based chronic disease management program since 2009 with hypertension a vital part of it
Research from the Chinese Center for Disease Control and Prevention [3] showed that in 2017, the number of people who expired due to hypertension-related diseases in China was 2.54 million, with approximately 69% died from stroke, 54% died from ischemic heart disease, and 41% died owing to other types of cardiovascular disease (CVD)
Despite the increasing emphasis on community-based management of hypertension in China [46], compliance [47], affordability, and treatment rates of patients that rely on traditional pharmacological interventions must be improved
Summary
The Chinese government has established a nationwide community-based chronic disease management program since 2009 with hypertension a vital part of it. Though drugs have been proven effective with hypertensive patients, they bring economic burden as well, especially for those who with elevated blood pressure and are potentially eligible for national programs. Research from the Chinese Center for Disease Control and Prevention [3] showed that in 2017, the number of people who expired due to hypertension-related diseases in China was 2.54 million, with approximately 69% died from stroke, 54% died from ischemic heart disease, and 41% died owing to other types of cardiovascular disease (CVD). Between 2005 and 2010, even with nearly 82% of American adults with hypertension aware of their status, and ∼75% taking antihypertensive drugs, only 47% of Abbreviations: CI, confidence interval; CVD, Cardiovascular disease; DBP, Diastolic blood pressure; ICER, Incremental cost effectiveness ratio; MD, Mean Difference; SBP, Systolic blood pressure
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