Zhang, Yanchun (2020) Economic Evaluation of Disease Management in China: The Case of Hypertension. PhD thesis, Victoria University.

Abstract

To combat the challenges of cardiovascular diseases (CVDs), the Chinese government launched a program in 2009 called the National Basic Public Health Service (NBPHS). This provides disease management services in primary healthcare facilities for hypertensive patients. Although a large amount of money has been invested since 2009, little is known about the benefits of such a large investment. Based on national datasets, this study conducted an economic evaluation of hypertension management in the NBPHS from 2009 to 2015. A trend model was built based on data from 1991 to 2009, which was used to predict hypertension control rates for 2015. The direct impact of the NBPHS on hypertensives was generated by comparing the predicted hypertension control with that of the observed levels in 2015. This generated a figure of 9,532,719 hypertensives who were able to get their blood pressure (BP) under control incrementally during 2009-2015. A hypothesized scenario in which the NBPHS had not been implemented was created to compare with the NBPHS scenario. Following the pathway of risk prediction studies on CVDs, a Markov model was developed to estimate the long-term health outcomes of the NBPHS by comparing the two scenarios from 2016 to 2045. It was estimated that at the end of the 30-year projection period, there would be 25,012, 296,258, and 744,493 hypertensive patients who would have avoided coronary heart disease, stroke and death, respectively, by being part of the NBPHS. A standard model of economic evaluation was developed by estimating gross domestic product increases from labour force participation and productivity gained by averting morbidities and mortalities. Net present value (NPV) was used to estimate healthcare expenditure saved, and the economic and social benefit of morbidity and mortality averted. It was predicted that from 2016 to 2045, there would be an economic benefit of 169,857 million CNY in NPV, or 267,297 million CNY when including social benefit. Given that hypertension management accounts for 14.59% of the NBPHS funding: the benefit-cost ratio would be 6.0 at a discount rate of 3%, and if the social benefit is included, the benefit-cost ratio would be 15.4 at the same discount rate. The internal rate of return would be 14.6% if only the economic benefit is considered and 20.7% if the social benefit is included. This is a very high benefit investment compared to that identified in other studies. This study contributes to academic knowledge by providing an economic framework of health interventions in primary healthcare settings in China. To some extent, it also fills a gap by addressing the economic evaluation of chronic disease interventions in China.

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