Journal Information
Vol. 13. Issue 5.
Pages 384-390 (September - October 1999)
Vol. 13. Issue 5.
Pages 384-390 (September - October 1999)
Open Access
Análisis de costes de la monitorización ambulatoria de la presión arterial en hipertensión leve
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J. Mar1,*, R. Pastor2,3, R. Abásolo4
1 Servicio de Gestión Clínica, Hospital Alto Deba. Mondragón, Guipúzcoa
2 Departamento de Epidemiología y Bioestadística, Escuela Nacional de Sanidad, Instituto de Salud Carlos III. Madrid
3 Departamento de Sanidad, Goberno Vasco. Vitoria
4 Centro de Salud Aranbizkarra II. Vitoria
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Resumen
Objetivo

Comparar los costes del método convencional y de la monitorización ambulatoria de la presión arterial (MAPA) en el diagnóstico, tratamiento y control de la hipertensión arterial (HTA) leve.

Métodos

Entre los pacientes con diagnóstico convencional de HTA leve, la MAPA discriminaría entre pacientes con HTA mantenida, que recibirían tratamiento, y pacientes con hipertensión de bata blanca (HBB), que serían simplemente vigilados. Los costes del diagnóstico, tratamiento y control se obtuvieron a partir de 446 hipertensos leves del Centro de Salud Aranbizkarra II (Vitoria) en 1996. Para ambos sexos, se estimó el coste global por paciente de las alternativas convencional y MAPA, en función de la edad media en el diagnóstico y de la proporción de HBB.

Resultados

Para una edad media en el momento del diagnóstico de 45 años y un 30% de HBB, el coste global por paciente en hombres fue de 414.999 pesetas en el método convencional y de 371.101 pesetas en el método MAPA. Entre 30 y 60 años, la alternativa MAPA resultó menos costosa que la convencional siempre que el porcentaje de HBB fue superior al 6%. Se obtuvieron resultados similares en mujeres con HTA leve.

Conclusiones

La MAPA puede ser aceptada como una herramienta de utilidad clínica para el cribado de pacientes con diagnóstico convencional de HTA leve. Por un lado, la MAPA permite seleccionar pacientes de bajo riesgo cardiovascular (HBB). Por otro, el ahorro derivado de la disminución del tratamiento farmacológico es superior al incremento del coste debido a la propia exploración.

Palabras clave:
análisis coste beneficio
determinación de la presión arterial
hipertensión
monitorización ambulatoria de la presión arterial
Summary
Background

To contrast the costs of conventional and ambulatory blood pressure monitoring (ABPM) methods in the diagnosis, treatment and follow-up of mild hypertensive patients.

Methods

Among patients with conventional diagnosis of mild hypertension, the ABPM would discriminate patients with sustained hypertension, who would receive drug treatment, from patients with white coat hypertension (WCH), who would be only followed up. The diagnosis, treatment and control costs were obtained from 446 mild hypertensive patients from the Primary Health Care Center Aranbizkarra II (Vitoria, Spain) during 1996. For each gender, the overall costs per patient were estimated in both conventional and ABPM methods in terms of mean diagnosis age and WCH percentage.

Results

For 45 years old patients and 30% of WCH, the overall costs per patient among men were 414,999 and 371,101 pesetas with conventional and ABPM methods, respectively. From 30 to 60 years old patients, the ABPM method turned up to be less expensive as long as the WCH percentage was higher than 6%. Similar results were obtained among women with mild hypertension.

Conclusions

ABPM can be accepted as an useful clinical tool for the screening of patients with conventional diagnosis of mild hypertension. On the one hand, ABPM allows to select patients with low cardiovascular risk (WCH). On the other hand, the savings resulting from treatment reduction and fewer physician visits are higher than the additional costs of ABPM recordings.

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Financiado parcialmente con la ayuda a la investigación del Fondo de Investigación Sanitaria (FIS 94/959).

Copyright © 1999. Sociedad Española de Salud Pública y Administración Sanitaria
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