Cost-effectiveness of screening for coronary artery disease in asymptomatic patients with type 2 diabetes and additional atherogenic risk factors
Cost-effectiveness of screening for coronary artery disease in asymptomatic patients with type 2 diabetes and additional atherogenic risk factors
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DOI：
10.1111/j.1525-1497.2004.40012.x
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发表时间：
2004-12-01
影响因子：
5.7
通讯作者：
Fukui, T
中科院分区：
文献类型：
--
作者：
Hayashino, Y;Nagata-Kobayashi, S;Fukui, T
目的：美国心脏病学会/美国糖尿病协会已推荐对有两个额外致动脉粥样硬化危险因素的无症状糖尿病患者进行冠状动脉疾病（CAD）筛查，但其成本效益尚未确定。本研究旨在评估筛查的成本效益并确定可接受的策略。设计：从社会角度使用马尔科夫模型进行成本效益分析，以衡量无症状糖尿病男性和两种额外的CAD筛查的临床获益和经济后果动脉粥样硬化危险因素。我们评估了按不同年龄组分层的患者队列，以及10种可能的致动脉粥样硬化风险组合。计算无筛查、运动心电图、运动超声心动图或运动单光子发射断层扫描（SPECT）的增量成本效益。输入数据来自已发表文献。结果表示为每质量调整生命年（QALY）的美元。测量和主要结果：与未筛查相比，在患有高血压和吸烟的60岁无症状糖尿病男性中，运动心电图的增量成本-效果比为41，600美元/QALY，但运动超声心动图的优势较弱。运动超声心动图最具成本效益，增量成本效益比为40，800美元/QALY。运动SPECT主要由其他策略。敏感性分析发现，结果不同，取决于年龄，其他致动脉粥样硬化危险因素的组合，和诊断测试performance.CONCLUSIONS：增量成本效益比CAD筛查无症状糖尿病患者和两个或两个以上的其他致动脉粥样硬化危险因素被证明是可以接受的，从社会的角度来看。运动超声心动图是最具成本效益的策略，其次是运动心电图。
OBJECTIVE: Screening for coronary artery disease (CAD) in asymptomatic diabetic patients with two additional atherogenic risk factors has been recommended by the American College of Cardiology/American Diabetes Association, but its cost-effectiveness is yet to be determined. The present study aims to evaluate the cost-effectiveness of screening and determine acceptable strategies.DESIGN: Cost-effectiveness analysis using a Markov model was performed from a societal perspective to measure the clinical benefit and economic consequences of CAD screening in asymptomatic men with diabetes and two additional atherogenic risk factors. We evaluated cohorts of patients stratified by different age groups, and 10 possible combination pairs of atherogenic risks. Incremental cost-effectiveness of no screening, exercise electrocardiography, exercise echocardiography, or exercise single-photon emission-tomography (SPECT) was calculated. Input data were obtained from the published literature. Outcomes were expressed as U.S. dollars per quality-adjusted life-year (QALY).MEASUREMENTS AND MAIN RESULTS: Compared with no screening, incremental cost-effectiveness ratio of exercise electrocardiography was $41,600/QALY in 60-year-old asymptomatic diabetic men with hypertension and smoking, but was weakly dominated by exercise echocardiography. Exercise echocardiography was most cost-effective, with an incremental cost-effectiveness ratio of $40,800/QALY. Exercise SPECT was dominated by other strategies. Sensitivity analyses found that results varied depending on age, combination of additional atherogenic risk factors, and diagnostic test performance.CONCLUSIONS: Incremental cost-effectiveness ratio of CAD screening in asymptomatic patients with diabetes and two or more additional atherogenic risk factors is shown to be acceptable from a societal perspective. Exercise echocardiography was the most cost-effective strategy, followed by exercise electrocardiography.