Health and Economic Implications of National Treatment Coverage for Cardiovascular Disease in India: Cost-Effectiveness Analysis.
Health and Economic Implications of National Treatment Coverage for Cardiovascular Disease in India: Cost-Effectiveness Analysis.
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DOI：
10.1161/circoutcomes.115.001994
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发表时间：
2015-11
期刊：
影响因子：
--
通讯作者：
Sood N
中科院分区：
文献类型：
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作者：
Basu S;Bendavid E;Sood N
是否支付心血管疾病费用是低收入和中等收入国家面临的一个日益紧迫的问题。我们试图确定扩大国民保险以覆盖印度心血管疾病的一级预防、二级预防和三级治疗的影响。我们将覆盖实验的数据纳入印度心肌梗死和中风的验证微观模拟模型，以评估替代覆盖策略的成本效益。与没有覆盖的现状相比，仅覆盖初级预防每年就节省了360万残疾调整生命年（DALY），每避免一个DALY的增量成本效益比为469美元。初级和二级预防的覆盖主要是一项覆盖初级预防和三级治疗的战略，与单独的初级预防相比，该战略预防了660万残疾调整生命年，每避免残疾调整生命年增加成本效益比为2241美元。与初级预防加三级治疗的覆盖范围相比，所有三个类别的结合产生了最大的影响，避免的每个DALY增量成本为5588美元。与没有覆盖的现状相比，覆盖所有3类预防/治疗的成本效益比增加了1331美元，每避免一次DALY。在敏感性分析中，即使依从性和获得治疗的机会较低，初级预防治疗的覆盖率仍然具有成本效益，但三级治疗的覆盖率将需要避免不必要的程序以保持成本效益。预计在印度，所有3种主要心血管治疗类型的覆盖范围将在广泛的可及性和依从性水平上产生高影响和合理的成本效益。
Whether to cover cardiovascular disease costs is an increasingly pressing question for low- and middle-income countries. We sought to identify the impact of expanding national insurance to cover primary prevention, secondary prevention, and tertiary treatment for cardiovascular disease in India. We incorporated data from coverage experiments into a validated microsimulation model of myocardial infarction and stroke in India to evaluate the cost-effectiveness of alternate coverage strategies. Coverage of primary prevention alone saved 3.6 million disability-adjusted life-years (DALY) per annum at an incremental cost-effectiveness ratio of $469 per DALY averted when compared with the status quo of no coverage. Coverage of primary and secondary preventions was dominated by a strategy of covering primary prevention and tertiary treatment, which prevented 6.6 million DALYs at an incremental cost-effectiveness ratio of $2241 per DALY averted, when compared with that of primary prevention alone. The combination of all 3 categories yielded the greatest impact at an incremental cost per DALY averted of $5588 when compared with coverage of primary prevention plus tertiary treatment. When compared with the status quo of no coverage, coverage of all 3 categories of prevention/treatment yielded an incremental cost-effectiveness ratio of $1331 per DALY averted. In sensitivity analyses, coverage of primary preventive treatments remained cost-effective even if adherence and access to therapy were low, but tertiary coverage would require avoiding unnecessary procedures to remain cost-effective. Coverage of all 3 major types of cardiovascular treatment would be expected to have high impact and reasonable cost-effectiveness in India across a broad spectrum of access and adherence levels.