Health Benefits and Cost-Effectiveness of Asymptomatic Screening for Hypertension and High Cholesterol and Aspirin Counseling for Primary Prevention
Health Benefits and Cost-Effectiveness of Asymptomatic Screening for Hypertension and High Cholesterol and Aspirin Counseling for Primary Prevention
复制标题
高血压和高胆固醇无症状筛查及阿司匹林初级预防咨询的健康效益和成本效益
DOI：
10.1370/afm.2015
复制
发表时间：
2017-01-01
影响因子：
4.4
通讯作者：
Flottemesch, Thomas J.
中科院分区：
文献类型：
--
作者：
Dehmer, Steven P.;Maciosek, Michael V.;Flottemesch, Thomas J.
目的我们的目的是更新国家预防优先委员会比较排名中推荐的心血管疾病一级预防(CVD)临床服务对健康和经济影响的估计，并探索不同性别和种族/民族的结果差异。方法我们使用一个单一的、集成的微模拟模型来生成美国预防服务工作组推荐的3项服务的可比结果：用于心血管疾病和结直肠癌一级预防的阿司匹林咨询，筛查和治疗血脂紊乱(通常是高胆固醇)，以及筛查和治疗高血压。分析从社会的角度比较了具有美国代表性的出生队列中10万人在获得和不能获得每项临床预防服务的情况下的一生结果。主要结果是健康影响，以生命质量调整寿命年(QALY)的净差额衡量，以及成本效益，以每QALY的增量成本或以2012年美元计算的人均成本节约衡量。结果高血压筛查和治疗对健康的影响最高(15,600 QALY)，紧随其后的是胆固醇筛查和治疗(14,300 QALY)。阿司匹林咨询对健康的影响较小(2200 QALY)，但被发现节省了成本(每人节省31美元)。胆固醇和高血压筛查和治疗的成本效益分别为每QALY 33,800美元和每QALY 48,500美元。与胆固醇筛查和治疗相比，女性更倾向于高血压筛查和治疗，对于非西班牙裔黑人人口来说，在所有服务中减轻疾病负担的机会最大。结论所有3种心血管疾病预防服务在美国成年人推荐的其他预防服务中仍然排名靠前，但在实践中可以根据患者的人口统计特征和临床目标定制个人优先事项。
PURPOSE Our aim was to update estimates of the health and economic impact of clinical services recommended for the primary prevention of cardiovascular disease (CVD) for the comparative rankings of the National Commission on Prevention Priorities, and to explore differences in outcomes by sex and race/ethnicity.METHODS We used a single, integrated, microsimulation model to generate comparable results for 3 services recommended by the US Preventive Services Task Force: aspirin counseling for the primary prevention of CVD and colorectal cancer, screening and treatment for lipid disorders (usually high cholesterol), and screening and treatment for hypertension. Analyses compare lifetime outcomes from the societal perspective for a US-representative birth cohort of 100,000 persons with and without access to each clinical preventive service. Primary outcomes are health impact, measured by the net difference in lifetime quality-adjusted life years (QALYs), and cost-effectiveness, measured in incremental cost per QALY or cost savings per person in 2012 dollars. Results are also presented for population subgroups defined by sex and race/ethnicity.RESULTS Health impact is highest for hypertension screening and treatment (15,600 QALYs), but is closely followed by cholesterol screening and treatment (14,300 QALYs). Aspirin counseling has a lower health impact (2,200 QALYs) but is found to be cost saving ($31 saved per person). Cost-effectiveness for cholesterol and hypertension screening and treatment is $33,800 per QALY and $48,500 per QALY, respectively. Findings favor hypertension over cholesterol screening and treatment for women, and opportunities to reduce disease burden across all services are greatest for the non-Hispanic black population.CONCLUSIONS All 3 CVD preventive services continue to rank highly among other recommended preventive services for US adults, but individual priorities can be tailored in practice by taking a patient's demographic characteristics and clinical objectives into account.