ストレステストを使用して,中等リスクの患者の間で冠動脈疾患のプライマリ予防をガイドする:費用対効果の分析
Benjamin Z Galper1, Andrew Moran, Pamela G Coxson
1Brigham and Women's Hospital, Cardiovascular Division, 75 Francis St, Boston, MA 02115, USA. bgalper@partners.org
Circulation
|December 7, 2011
まとめ
冠動脈疾患の初次予防には,アスピリンとスタチンを用いた全治戦略が最も費用対効果的です. 非侵襲的な心臓ストレステストは,服薬の遵守を大幅に改善しない限り,薬剤の使用をガイドするために費用対効果が高くありません.
科学分野:
- 心血管疾患の予防 心血管疾患の予防
- 健康経済学 医療経済学
- 予防性心臓病学 予防性心臓病学
背景:
- 非侵襲的ストレステストは,冠動脈性心疾患 (CHD) の初次予防のためにアスピリンとスタチンの使用をガイドすることができます.
- 予防的な薬物療法戦略を導くためにストレステストを使用する費用対効果は不明です.
研究 の 目的:
- アスピリンとスタチンを用いたCHDの初次予防のための異なる戦略の費用対効果を比較する.
- 予防的な薬物使用の最適化における非侵襲的ストレステストの役割を評価する.
主な方法:
- シミュレーションモデルでは,現状,成人治療パネルIIIのガイドライン,全治療戦略,およびストレス電気心臓撮影を用いたテスト・アンド・トリートメント戦略の4つの戦略を比較した.
- 2011年から2040年にかけての医療費の予測,CHDのイベント,および品質調整された寿命年数
主要な成果:
- トリート・オール戦略 (スタチンとアスピリンの普遍的な使用が中等リスクの個人に適用される) は,最も効果的で最も費用が安かった.
- ストレス用心電図は,他のテスト・アンド・トリートメント戦略よりも効果的であり,費用も安かったが,一般的にトリート・オール戦略よりも優れなかった.
- ストレステストは,スタチンの高額な費用,または著しく改善された遵守などの特定の条件下でのみ費用対効果的になりました.
結論:
- 非侵襲的な心臓ストレステストは,アスピリンやスタチンのような予防薬をターゲットにするための費用対効果の高い戦略ではありません.
- 心血管疾患の初次予防のための普遍的な"すべて治療"アプローチは,ジェネリックスタチンが利用可能である場合,より費用対効果が高くなります.
- ストレステストが費用対効果が高く,予防的治療の指針となるためには,薬剤の遵守の大幅な改善が必要である.
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