Cost-Outcome Analysis of Hypertension Treatment at The Out-Patient Department: a Comparison Across Public Health Insurance Schemes - การวิเคราะห์ต้นทุนผลลัพธ์ในการรักษา โรคความดันโลหิตสูงทีแผนกผ้ป่วยนอก เปรียบเทียบระหว่างกองทุนประกันสุขภาพของรัฐ

บทคัดย่อ

              This study aims to perform a cost-outcome analysis of hypertension (HT) treatment in uncomplicated HT patients across health insurance plans. A total of 4,353 patients who were treated at the outpatient (OP) department at Suratthani Hospital in 2014 were identified: 2,247 enrolled in Universal Coverage (UC), 149 in Social Security Scheme (SSS), and 1,957 in Civil Servants’ Medical Benefit Scheme (CSMBS). Patients’ data were retrieved from electronic medical records. Direct medical costs of HT treatment were estimated from resources used in the OP care of HT, including the unit costs of OP visit, costs of laboratory tests, anti-hypertensive medications, and other HT-related treatments. Costs of HT treatment were approximated from 4 perspectives: societal, patient, healthcare payer, and provider, with base year 2014. Treatment outcome was well-controlled blood pressure (BP), defined as having systolic BP<140 mmHg and diastolic BP<90 mmHg. Chi-square and ANOVA were used in the statistical analysis, with a significance level of 0.05. Findings indicated that the proportion of patients with well-controlled BP was not significantly different across health insurance types. From all perspectives, the costs of HT treatment were much higher in CSMBS beneficiaries, compared to their colleagues. Among 3 health insurances, the cost-effectiveness ratios of HT treatment were highest in CSMBS beneficiaries. Compared with their counterparts, CSMBS beneficiaries receive HT treatment that demonstrates inefficient use of resources. Future research that explores interventions which could improve the cost-effectiveness of HT treatment, particularly among CSMBS patients, is recommended.

Key words: hypertension, cost, outcome, out-patient, health insurance