Chronic diseases 4 - Prevention of cardiovascular disease in high-risk individuals in low-income and middle-income countries: health effects and costs
Chronic diseases 4 - Prevention of cardiovascular disease in high-risk individuals in low-income and middle-income countries: health effects and costs
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DOI：
10.1016/s0140-6736(07)61699-7
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发表时间：
2007-12-15
期刊：
影响因子：
168.9
通讯作者：
Rodgers, Anthony
中科院分区：
文献类型：
--
作者：
Lim, Stephen S.;Gaziano, Thomas A.;Rodgers, Anthony
2005年，全球制定了每年将慢性病死亡率再降低2%的目标。扩大循证干预措施的覆盖面，以预防低收入和中等收入国家高危人群的心血管疾病，可以在实现这一目标方面发挥重要作用。我们的目的是估计在23个这样的国家中，可以避免的死亡人数以及在现有覆盖水平之上扩大预防心血管疾病的多药方案（他汀类药物，阿司匹林和两种降压药物）的财务成本。确定的个人仅限于那些已经获得保健服务的人，治疗资格的依据是现有心血管疾病的存在或使用容易测量的风险因素确定的心血管疾病的绝对风险。在10年的时间里，扩大这种多药物治疗方案可以避免1790万人死于心血管疾病（95%不确定性区间为740万-2570万）。56%的避免死亡将发生在70岁以下的人身上，由于年龄较大的妇女的绝对人数较多，妇女避免的死亡人数多于男子。10年的财政成本将为470亿美元（330亿至610亿美元），人均年成本为1.08美元（0.75至1.40美元），从0.43美元至0.45美元不等。低收入国家从0.54美元增加到2.93美元，中等收入国家从0.54美元增加到2.93美元。这一一揽子计划可以有效地实现拟议全球目标的四分之三，同时适度增加卫生支出。
In 2005, a global goal of reducing chronic disease death rates by an additional 2% per year was established. Scaling up coverage of evidence-based interventions to prevent cardiovascular disease in high-risk individuals in low-income and middle-income countries could play a major part in reaching this goal. We aimed to estimate the number of deaths that could be averted and the financial cost of scaling up, above current coverage levels, a multidrug regimen for prevention of cardiovascular disease (a statin, aspirin, and two blood-pressure-lowering medicines) in 23 such countries. Identification of individuals was limited to those already accessing health services, and treatment eligibility was based on the presence of existing cardiovascular disease or absolute risk of cardiovascular disease by use of easily measurable risk factors. Over a 10-year period, scaling up this multidrug regimen could avert 17.9 million deaths from cardiovascular disease (95% uncertainty interval 7.4 million-25.7 million). 56% of deaths averted would be in those younger than 70 years, with more deaths averted in women than in men owing to larger absolute numbers of women at older ages. The 10-year financial cost would be US$47 billion ($33 billion-$61 billion) or an average yearly cost per head of $1.08 ($0.75-1.40), ranging from $0.43 to $0. 90 across low-income countries and from $0.54 to $2.93 across middle-income countries. This package could effectively meet three-quarters of the proposed global goal with a moderate increase in health expenditure.