Cost-effectiveness of lower targets for blood pressure and low-density lipoprotein cholesterol in diabetes: the Stop Atherosclerosis in Native Diabetics Study (SANDS) .
Cost-effectiveness of lower targets for blood pressure and low-density lipoprotein cholesterol in diabetes: the Stop Atherosclerosis in Native Diabetics Study (SANDS) .
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DOI：
10.1016/j.jacl.2010.01.008
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发表时间：
2010-05
影响因子：
4.4
通讯作者：
Ratner RE
中科院分区：
文献类型：
--
作者：
Wilson C;Huang CC;Shara N;Howard BV;Fleg JL;Henderson JA;Howard WJ;Huentelman H;Lee ET;Mete M;Russell M;Galloway JM;Silverman A;Stylianou M;Umans J;Weir MR;Yeh F;Ratner RE
The Stop Atherosclerosis in Native Diabetics Study (SANDS) reported cardiovascular benefit of aggressive versus standard treatment targets for both low-density lipoprotein cholesterol (LDL-C) and blood pressure (BP) in diabetic individuals. In this analysis, we examined within trial cost-effectiveness of aggressive targets of LDL-C ≤70 mg/dL and systolic blood pressure (SBP) ≤115 mmHg vs. standard targets of LDL-C ≤100 mg/dL and SBP ≤130 mmHg. Randomized, open label blinded-to-endpoint 3-year trial. SANDS clinical trial database, Quality of Wellbeing (QWB) survey, Centers for Medicare and Medicaid Services, Wholesale Drug Prices. American Indians ≥ age 40 years with type 2 diabetes and no prior cardiovascular events. April 2003-July 2007. Health payer. Participants were randomized to aggressive vs. standard groups with treatment algorithms defined for both. Incremental cost-effectiveness. Compared with the standard group, the aggressive group had slightly lower costs of medical services ($-116), but a 54% higher cost for BP medication ($1,242) and a 116% higher cost for lipid-lowering medication ($2,863), resulting in an increased cost of $3,988 over 3 years. Those in the aggressively treated group gained 0.0480 quality-adjusted life-years (QALY) over the standard group. Using a 3% discount rate for costs and outcomes, the resulting cost per QALY was $82,589. Using a 25%, 50%, and 75% reduction in drug costs resulted in a cost per QALY of $61,329, $40,070, and $18,810, respectively. This study was limited by use of a single ethnic group and by its 3-year duration. Within this 3-year study, treatment to lower BP and LDL-C below standard targets was not cost-effective due to the cost of the additional medications required to meet the lower targets. With the anticipated availability of generic versions of the BP and lipid-lowering drugs used in SANDS, cost-effectiveness of this intervention should improve.
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影响因子：
4.8
作者：
Russell, Marie;Fleg, Jerome L.;Howard, Barbara V.
通讯作者：
Howard, Barbara V.
影响因子：
--
作者：
Herman, WH
通讯作者：
Herman, WH
影响因子：
16.2
作者：
Keech, A;Colquhoun, D;Tonkin, A
通讯作者：
Tonkin, A
影响因子：
3.8
作者：
TENGS, TO;ADAMS, ME;GRAHAM, JD
通讯作者：
GRAHAM, JD
影响因子：
16.2
作者：
Knopp, Robert H.;D'Emden, Michael;Pocock, Stuart J.
通讯作者：
Pocock, Stuart J.