通过动脉样硬化心血管风险查无症状动脉狭窄症的成本效益
medRxiv : the preprint server for health sciences
|May 27, 2024
概括
针对无症状动脉狭窄症 (ACAS) 的向查对有高动脉样硬化心血管疾病 (ASCVD) 风险的个人来说最具成本效益. 这种方法可以通过识别那些从干预中获益最多的人来预防成千上万的中风.
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:
- 额外内动脉狭窄 (50-99%的狭窄) 是缺血性中风的重要危险因素.
- 针对无症状动脉狭窄症 (ACAS) 进行向查的成本效益在以人口为基础的研究中尚未得到充分证实.
研究的目的:
- 为了估计一次性,有针对性的ACAS查计划的成本效益.
- 根据动脉样硬化心血管疾病 (ASCVD) 风险对查资格进行分层,使用美国心脏协会的聚合队列方程.
主要方法:
- 开发了一种ACAS和中风的终身微型模拟模型,用于50-80岁的美国成年人,以前没有中风.
- 使用心血管健康研究数据估计ACAS的概率和严重程度.
- 模拟重血管化>70%狭窄,评估中风风险降低与并发症风险.
主要成果:
- 查10年ASCVD风险>30%的个体是最具成本效益的策略 (ICER:89000美元/QALY).
- 这一策略将对11.9%的人口进行查,可能避免24,084次中风.
- 查较低ASCVD风险组 (0-20%) 只有0.6%的机会具有成本效益.
结论:
- 一次性ACAS查对高ASCVD风险的成年人来说是最具成本效益的.
- 研究结果提供了一个适应未来临床试验数据的框架,用于重血管化和医疗治疗.
- 强调风险分层在优化中风预防策略中的重要性.
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