economic analysis of a pragmatic randomised trial of home visits by a nurse to elderly people with hypertension in mexico análisis económico de un ensayo clínico aleatorizado de visitas de enfermera en casa a ancianos con hipertensión en méxico

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ID: 181159
2002
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Abstract
Objective. To analyse the costs and the effectiveness of an intervention of home visits made by nurses to elderly people versus usual care given by the family medicine units. Material and Methods. A sample of 4 777 subjects aged 60 years and over covered by the Mexican Institute of Social Security (Instituto Mexicano del Seguro Social, IMSS) were screened. Those with a systolic and/or diastolic blood pressure level higher or equal than 160/90 mm Hg were randomly allocated to the intervention or control groups. The intervention consisted of visits at home by nurses who gave health and lifestyle advice to the participants. The economic evaluation was considered from a health services and patient perspective. Direct and indirect costs were calculated as incremental. Effectiveness was measured in terms of cost per millimetre of mercury reduced. Results. Three hundred and forty five participants were allocated to the intervention group and compared with 338 controls. At the end of the intervention period the difference in the mean change in systolic blood pressure was 3.31 mm Hg (95% CI 6.32, 0.29; p=0.03) comparing with the control group. In diastolic blood pressure the difference was 3.67 (95% CI 5.22, 2.12; p<0.001). The total cost of the intervention was 101 901.66 pesos. The intervention cost per patient was 34.61 pesos (US$3.78), (CI 95% 34.44, 35.46). The cost-effectiveness ratios was 10.46 pesos (US$1.14) for systolic (CI 95% 129.31, 5.51) and 9.43 (US$1.03) for diastolic (CI 95% 19.90, 2.49). Conclusions. The reduction in blood pressure obtained may well justify the small incremental cost of the intervention.
Objetivo. Analizar los costos y la efectividad de una intervención basada en visitas de enfermería en casa a ancianos hipertensos comparada con el tratamiento usual otorgado por el médico familiar. Material y métodos. Una muestra de 4 777 sujetos de 60 años y más derechohabientes del Instituto Mexicano del Seguro Social (IMSS) fueron sometidos a escrutinio. Aquellos con cifras sistólica o diastólica iguales o superiores a 160/90 mm Hg fueron asignados aleatoriamente al grupo de intervención o al control. La intervención consistió en visitas de enfermera en casa que daban promoción de la salud. La evaluación económica fue considerada desde una perspectiva del paciente y de los servicios de salud. Costos directos e indirectos fueron considerados como incrementales. La efectividad fue medida en términos de costo por mmHg reducido. Resultados. Trescientos cuarenta y cinco participantes fueron aleatorizados al grupo de intervención y comparados con 338 controles. Al final del periodo de intervención la diferencia en el cambio promedio en presión arterial sistólica fue de 3.31 mm Hg (IC 95% 6.32, 0.29; p=0.03) comparado con el grupo control. La diferencia en presión arterial diastólica fue de 3.67 mm Hg (IC 95% 5.22, 2.12; p<0.001). El costo total de la intervención fue de 101,901.66 pesos. El costo por paciente fue de 34.61 pesos (US$3.78), (IC 95% 34.44, 35.46). La razón de costo efectividad fue de 10.46 pesos (US$1.14) para presión sistólica (IC 95% 129.31, 5.51) y 9.43 (US$1.03) para presión diastólica (IC 95% 19.90, 2.49). Conclusiones. La reducción de la presión arterial parece valer el costo incremental de la intervención.
Reference Key
garca-pea2002saludeconomic Use this key to autocite in the manuscript while using SciMatic Manuscript Manager or Thesis Manager
Authors ;Carmen García-Peña;Margaret Thorogood;David Wonderling;Sandra Reyes-Frausto
Journal journal of anatomy
Year 2002
DOI
DOI not found
URL
http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0036-36342002000100002
Keywords
hypertension mexico cost effectiveness elderly population mexicopublic aspects of medicine hipertensión

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