The cost-effectiveness of implementing a new guideline for cardiovascular risk management in primary care in the Netherlands
The cost-effectiveness of implementing a new guideline for cardiovascular risk management in primary care in the Netherlands
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DOI：
10.1097/hjr.0b013e328329497a
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发表时间：
2009-06-01
影响因子：
--
通讯作者：
Verschuren, Monique W. M.
中科院分区：
文献类型：
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作者：
Kok, Linda;Engelfriet, Peter;Verschuren, Monique W. M.
背景一项新的荷兰心血管疾病管理指南大大增加了推荐使用他汀类药物和/或抗高血压药物治疗的个体数量。我们估计了在国家层面实施新指南的成本效益。方法首先，根据最近的一项人口研究数据，估计在新指南下有资格接受降胆固醇或抗高血压治疗的目前未接受治疗的个人数量。结果在30-69岁年龄组实施该指南将导致额外465000人需要治疗。未来20年，全人群急性心肌梗死累计发病率将下降3.0%，卒中累计发病率将下降3.9%，全因死亡率将下降0.9%。寿命成本-效果比计算为每获得质量调整寿命年15000 E。在70-79岁和80岁及以上年龄组，每质量调整生命年需要治疗的人数分别增加600000人和450000人，相应地，累积发病率下降14%和18%(急性心肌梗死)，17%和22%(中风)，1.2%和0.6%(全因死亡)，成本-效果比分别为20800和32300E。这将是具有成本效益的，直到70岁。欧洲心脏病学会杂志16：371-376(C)2009
Background A new Dutch guideline for cardiovascular disease management substantially extends the number of individuals for whom treatment with statins and/or anti hypertensive agents is recommended. We estimated the cost-effectiveness of implementing the new guideline at the national level.Methods First, the number of currently untreated individuals who would become eligible for cholesterol-lowering or anti hypertensive treatment under the new guideline was estimated using data from a recent population study. Cost-effectiveness of treating this group of patients was then assessed using a mathematical model.Results Implementing the guideline in the age category 30-69 years would lead to an additional 465000 individuals requiring treatment. Over a period of 20 years, the cumulative incidence of acute myocardial infarction in the whole population would drop by 3.0%, that of stroke by 3.9%, and all-cause mortality would drop by 0.9%. The lifetime cost-effectiveness ratio was calculated to be 15000 E per quality-adjusted life year gained. In the age categories 70-79 years and 80 years or above, an additional 600000 and 450000 persons, respectively, would need to be treated, resulting in corresponding reductions in cumulative incidences of 14 and 18% (acute myocardial infarction), 17 and 22% (stroke), and 1.2 and 0.6% (all-cause morality) with cost-effectiveness ratios of 20 800 and 32 300 E, respectively, per quality-adjusted life year.Conclusion Complete implementation of the new guideline would lead to a considerable increase in the number of individuals requiring treatment. This would be cost-effective up to the age of 70 years. Eur J Cardiovasc Prev Rehabil 16:371-376 (C) 2009 The European Society of Cardiology