使用压力测试来指导中等风险患者冠心病的初级预防:一个成本效益分析
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
概括
对于冠心病的初级预防,使用阿司匹林和他类药物的全方位治疗策略是最具成本效益的. 非侵入性心脏应激测试对于指导药物使用是不具有成本效益的,除非它能显著改善药物坚持.
科学领域:
- 预防心血管疾病 预防心血管疾病
- 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:
- 非侵入性压力测试可以指导阿司匹林和他类药物用于冠心病 (CHD) 的初级预防.
- 使用压力测试来指导预防性药物治疗策略的成本效益仍然不清楚.
研究的目的:
- 为了比较使用阿司匹林和他类药物进行心血管疾病初级预防的不同策略的成本效益.
- 评估非侵入性压力测试在优化预防性药物使用中的作用.
主要方法:
- 一个模拟模型比较了四种策略:现状,成人治疗小组III指导方针,全方位策略和使用压力心电图的测试和治疗策略.
- 从2011年到2040年,预计的医疗保健费用,CHD事件和经质量调整的寿命年数.
主要成果:
- 全方位治疗策略 (对中等风险个体普遍使用他类药物和阿司匹林) 是最有效和最便宜的.
- 压力心电图比其他测试和治疗策略更有效,更便宜,但通常不优于全方位治疗策略.
- 只有在特定条件下,压力测试才变得具有成本效益,例如高的他类药物成本或显著改善的坚持.
结论:
- 非侵入性心脏应激测试不是针对阿司匹林和他类预防药物的成本有效策略.
- 当通用他类药物可用时,通用"治疗所有"方法用于初级预防心血管疾病的成本效益更高.
- 为了使压力测试在指导预防性治疗中具有成本效益,需要在药物坚持方面取得重大改进.
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