在低成本的他类药物时代,他类药物治疗用于初级预防的成本效益
Lawrence D Lazar1, Mark J Pletcher, Pamela G Coxson
1Cleveland Clinic Foundation, Cleveland, Ohio, USA.
Circulation
|June 29, 2011
概括
低成本的他类药物对心血管疾病的初级预防具有成本效益,即使对于胆固醇略高或存在风险因素的人来说也是如此. 扩大这些负担得起的药物的使用提供了显著的健康益处,而没有实质性的风险.
科学领域:
- 心血管医学 心血管医学
- 卫生经济学 卫生经济学
- 预防性心脏病学 预防性心脏病学
背景情况:
- 低成本仿制药的广泛可用性降低了初级预防的成本.
- 以前的成本效益分析可能不反映当前的通用定价和扩展的处方策略.
研究的目的:
- 预测使用低成本仿制药扩大他类药物处方策略的成本效益.
- 确定在哪些条件下,激进的他类药物处方可能不再具有成本效益.
主要方法:
- 使用了一种冠心病政策模型,即模拟美国35岁以上人口的马尔科夫模型.
- 模拟评估了基于低密度脂蛋白胆固醇水平和冠心病风险因素的扩展性他类药物处方值.
主要成果:
- 以每月4美元的价格扩大他类药物的使用,LDL胆固醇的值>160毫克/分升 (低风险),>130毫克/分升 (中等风险) 和>100毫克/分升 (中等风险),每年可以节省4.3亿美元.
- 进一步降低值并治疗所有中等风险的个体,无论LDL胆固醇是多少,都会带来额外的健康益处,即每年9900美元的质量调整寿命.
- 结果与大多数不良影响假设相一致,但对降低他类药物的疗效或显著的长期患者报告的不实用性敏感.
结论:
- 低成本的他类药物是适度升高胆固醇或任何冠状动脉心脏病风险因素的个体的初级预防的成本效益.
- 副作用不太可能在有效的人群中否定他类药物的益处.
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