Economic return from the Women's Health Initiative estrogen plus progestin clinical trial: a modeling study.
Economic return from the Women's Health Initiative estrogen plus progestin clinical trial: a modeling study.
复制标题
妇女健康计划的经济回报雌激素加孕激素临床试验：一项建模研究。
DOI：
10.7326/m13-2348
复制
发表时间：
2014-05-06
影响因子：
39.2
通讯作者：
Ramsey SD
中科院分区：
文献类型：
--
作者：
Roth JA;Etzioni R;Waters TM;Pettinger M;Rossouw JE;Anderson GL;Chlebowski RT;Manson JE;Hlatky M;Johnson KC;Ramsey SD
妇女健康倡议(WHI)雌激素+孕激素(E+P)试验的结果导致美国绝经后妇女使用联合激素疗法(CHT)的大幅减少。这一转变的经济影响还没有相对于2.6亿美元的试验成本(2012年美元)进行评估。评估WHI E+P试验的经济回报。根据试验前推算出的“WHI情景”和“非WHI情景”，分别模拟CHT使用情况下的健康结果。对WHI结果、同行评议文献和政府来源的初步分析。美国的绝经后妇女，年龄在50岁到79岁之间，没有做过子宫切除术。2003年至2012年。付款人。激素联合疗法。疾病发病率、费用、质量调整寿命年和净经济收益。WHI方案的结果是，使用CHT的人数减少了430万，乳腺癌病例减少了12.6万，心血管疾病病例减少了76000，骨折增加了26.3万，质量调整后的寿命年增加了14.5万，支出节省了352亿美元。该试验的相应净经济回报为371亿美元(试验投资的每美元140美元)，按每质量调整寿命年10万美元的支付意愿水平计算。试验净经济回报的95%可信区间为23.1至512亿美元。没有对2012年之后的间接成本或结果进行评估。WHI E+P试验高价值地使用了公共资金，获得了可观的投资回报。这些结果有助于讨论公共资金在对公共卫生有很大潜在影响的大型前瞻性试验中的作用。国家心肺血液研究所。
The findings of the Women’s Health Initiative (WHI) estrogen plus progestin (E+P) trial led to a substantial reduction in use of combined hormone therapy (cHT) among postmenopausal women in the United States. The economic effect of this shift has not been evaluated relative to the trial’s $260 million cost (2012 U.S. dollars). To estimate the economic return from the WHI E+P trial. Decision model to simulate health outcomes for a “WHI scenario” with observed cHT use and a “no-WHI scenario” with cHT use extrapolated from the pretrial period. Primary analyses of WHI outcomes, peer-reviewed literature, and government sources. Postmenopausal women in the United States, aged 50 to 79 years, who did not have a hysterectomy. 2003 to 2012. Payer. Combined hormone therapy. Disease incidence, expenditure, quality-adjusted life-years, and net economic return. The WHI scenario resulted in 4.3 million fewer cHT users, 126 000 fewer breast cancer cases, 76 000 fewer cardiovascular disease cases, 263 000 more fractures, 145 000 more quality-adjusted life-years, and expenditure savings of $35.2 billion. The corresponding net economic return of the trial was $37.1 billion ($140 per dollar invested in the trial) at a willingness-to-pay level of $100 000 per quality-adjusted life-year. The 95% CI for the net economic return of the trial was $23.1 to $51.2 billion. No evaluation of indirect costs or outcomes beyond 2012. The WHI E+P trial made high-value use of public funds with a substantial return on investment. These results can contribute to discussions about the role of public funding for large, prospective trials with high potential for public health effects. National Heart, Lung, and Blood Institute.