心血管疾患のプライマリ予防における共同意思決定のための患者アクセス可能なツール:長寿の利益と薬物使用不便のバランスをとる
Marianna Fontana1, Perviz Asaria1, Michela Moraldo1
1International Centre for Circulatory Health, National Heart and lung Institute, Imperial College London, UK.
Circulation
|April 19, 2014
まとめ
多くの患者が予防薬の服用を中止するのは,無効性,日用錠剤の不便性によるものです. この研究では,薬剤の無効性が,特にリスクが低い個体において,スタチンによる短い寿命を上回ることがしばしば示された.
科学分野:
- 心血管疾患予防 心血管疾患予防
- 健康経済学とは
- 行動医学は,行動医学である.
背景:
- 主要予防のガイドラインでは,患者の薬に対する嫌悪感がしばしば見過ごされている.
- ほとんどの患者は,3年以内に初等予防スタチンを中止します.
- 薬剤の無効性は,従順性の重要な要因です.
研究 の 目的:
- 薬の無効性の現実世界の分布を定量化するために.
- 様々な心血管リスク層の平均ユーティリティを計算する.
- 薬の無効性をスタチンによる期待される長寿増加と比較するために.
主な方法:
- ロンドンで360人の一般市民のランダムサンプリング.
- 不有用性を相殺するために必要な寿命増加に応じて量化された薬剤嫌悪.
- リスクプロファイル全体でスタチン療法による予想される寿命増加 (ユーティリティ) の計算.
主要な成果:
- 観察された薬物使用不足は,1日から10年以上 (中位は6ヶ月) まで幅広く変化しました.
- スタチンによる平均寿命増加率は,50歳以上で,平均3.6~24.3ヶ月であった.
- 25%以上の被験者は,高リスクグループにおける平均寿命の伸びを上回る不便性を有していた.
結論:
- 薬剤の無効性は,プライマリー予防において軽視できないと仮定することはできません.
- スタチンの平均寿命の利点を超えることができる.
- 将来の研究では,より大きな集団における薬剤の無効性,および臨床コンサルティングを調査する必要があります.
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