Using electronic health records to predict costs and outcomes in stable coronary artery disease.
Using electronic health records to predict costs and outcomes in stable coronary artery disease.
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DOI：
10.1136/heartjnl-2015-308850
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发表时间：
2016-05-15
期刊：
影响因子：
--
通讯作者：
Sculpher M
中科院分区：
文献类型：
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作者：
Asaria M;Walker S;Palmer S;Gale CP;Shah AD;Abrams KR;Crowther M;Manca A;Timmis A;Hemingway H;Sculpher M
使用电子健康记录（EHR）来预测稳定型冠状动脉疾病（stable-CAD）患者的终身成本和健康结局，并评估针对这些人群的治疗的成本效益。该分析基于2001年至2010年期间英国94966例稳定型CAD患者，这些患者在4个前瞻性收集的相关EHR来源中确定。 马尔可夫模型用于估计终身成本和质量调整生命年（QHLS）分层基线心血管风险。对于风险最低的十分之一的稳定型CAD患者，预测的贴现剩余终身医疗费用和QDs分别为62 210英镑（95% CI 33 724英镑至90 043英镑）和12.0（95% CI 11.5至12.5）年。 对于最高风险的十分之一人群，等效成本和QDLS分别为35 549英镑（95% CI 31 679英镑至39 615英镑）和2.9（95% CI 2.6至3.1）年。 如果最低风险患者的价格低于每年72英镑，最高风险患者的价格低于每年646英镑，那么心肌梗死，中风和心血管疾病死亡风险降低20%且无副作用的新治疗方法将具有成本效益。现有的EHR可用于估计稳定型CAD患者的终身医疗费用和结局。在这项研究中开发的稳定CAD模型有助于通知有关委托，定价和报销的决定。在目前的价格下，为了具有成本效益，一些已建立的以及未来的稳定CAD治疗可能需要根据患者风险进行分层。
To use electronic health records (EHR) to predict lifetime costs and health outcomes of patients with stable coronary artery disease (stable-CAD) stratified by their risk of future cardiovascular events, and to evaluate the cost-effectiveness of treatments targeted at these populations. The analysis was based on 94 966 patients with stable-CAD in England between 2001 and 2010, identified in four prospectively collected, linked EHR sources. Markov modelling was used to estimate lifetime costs and quality-adjusted life years (QALYs) stratified by baseline cardiovascular risk. For the lowest risk tenth of patients with stable-CAD, predicted discounted remaining lifetime healthcare costs and QALYs were £62 210 (95% CI £33 724 to £90 043) and 12.0 (95% CI 11.5 to 12.5) years, respectively. For the highest risk tenth of the population, the equivalent costs and QALYs were £35 549 (95% CI £31 679 to £39 615) and 2.9 (95% CI 2.6 to 3.1) years, respectively. A new treatment with a hazard reduction of 20% for myocardial infarction, stroke and cardiovascular disease death and no side-effects would be cost-effective if priced below £72 per year for the lowest risk patients and £646 per year for the highest risk patients. Existing EHRs may be used to estimate lifetime healthcare costs and outcomes of patients with stable-CAD. The stable-CAD model developed in this study lends itself to informing decisions about commissioning, pricing and reimbursement. At current prices, to be cost-effective some established as well as future stable-CAD treatments may require stratification by patient risk.