Resource implications and health benefits of primary prevention strategies for cardiovascular disease in people aged 30 to 74: mathematical modelling study
Resource implications and health benefits of primary prevention strategies for cardiovascular disease in people aged 30 to 74: mathematical modelling study
复制标题
DOI：
10.1136/bmj.325.7357.197
复制
发表时间：
2002-07-27
影响因子：
105.7
通讯作者：
Rouse, A
中科院分区：
文献类型：
--
作者：
Marshall, T;Rouse, A
目的建立一个模型，以确定在初级保健中实施心血管疾病预防指南的资源成本和健康效益，设计心血管疾病预防六种策略的数据建模。策略包括两种识别患者进行评估的方法：传统（对所有成年人进行评估）和新颖（预先选择患者，使用事先估计的心血管疾病风险进行评估）。三种治疗策略与每一种识别策略相结合进行建模。设置英格兰。受试者年龄30至74岁的患者符合心血管疾病的一级预防策略，这些患者选自2000年的假设人群。主要结果测量评估符合条件的成年人的资源成本，提供治疗和随访以及这应该预防的心血管事件的数量。结果新的策略以较低的成本预防了更多的心血管疾病，而不是传统的战略。一些治疗策略比其他治疗策略用更少的资源预防更多的心血管疾病。研究结果是强大的一系列不同的假设工作量。结论预选患者进行评估，更好地利用工作人员的时间比评估所有的成年人。用低成本药物治疗许多患者比给少数患者开强化降压药和他汀类药物更有效。指南的作者应该模拟遵循他们的建议的工作量影响和健康益处。
Objective To develop a model to determine the resource costs and health benefits of implementing guidelines for the prevention of cardiovascular disease in primary care,Design Modelling of data from six strategies for prevention of cardiovascular disease. Strategies incorporated two ways of identifying patients for assessment: traditional (assessment of all adults) and novel (preselection of patients For assessment using a prior estimate of their risk of cardiovascular disease). Three treatment strategies were modelled in conjunction with each identification strategy.Setting England.Subjects Patients aged 30 to 74 eligible for primary prevention strategies for cardiovascular disease who were selected from a hypothetical population of 2000.Main outcome measures Resource costs of assessing eligible adults, providing treatment and follow up and number of cardiovascular events this should prevent.Results Novel strategies prevented more cardiovascular disease, at lower cost, than traditional strategies. Some treatment strategies prevent more cardiovascular disease with fewer resources than others. The findings were robust across a range of different assumptions about workload.Conclusion Preselecting patients for assessment makes better use of staff time than assessing all adults. Treating many patients with low cost drugs is more efficient than prescribing a few patients intensive antihypertensives and statins. Authors of guidelines should model workload implications and health benefits of following their recommendations.