全民查慢性病:一个成本效益分析
Marika M Cusick1, Rebecca L Tisdale2,3, Glenn M Chertow1,4,5
1Department of Health Policy, Stanford School of Medicine, and Stanford Health Policy, Freeman Spogli Institute for International Studies, Stanford University, Stanford, California.
JAMA health forum
|November 8, 2024
概括
在55岁时开始全民慢性病 (CKD) 查,结合-葡萄糖共运输体-2 (SGLT2) 抑制剂,具有成本效益. 这一策略减少了功能衰竭,增加了预期寿命,在既定成本基准范围内提供了显著的健康益处.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學專業.
- 公共卫生 公共卫生
- 卫生经济学 卫生经济学
背景情况:
- -葡萄糖共运输体-2 (SGLT2) 抑制剂已经推进了慢性病 (CKD) 管理.
- 现在可以对全人口进行CKD查,但最佳发病年龄需要评估.
研究的目的:
- 为了比较全民CKD查在不同年龄和频率的临床益处,成本和成本效益.
- 确定在一般人群中启动CKD查的最佳年龄.
主要方法:
- 使用马尔科夫队列模型模拟美国35岁以上成年人CKD进展的成本效益分析.
- 来自NHANES,DAPA-CKD试验和医疗保险来源的数据被用于校准和有效性估计.
- 查策略包括从35岁到75岁之间对白色素尿的测试,使用或不使用SGLT2抑制剂,频率不同.
主要成果:
- 在55岁时每5年进行一次查,使用SGLT2抑制剂,从2.4%降低了功能衰竭的发病率到1.9%,预期寿命增加了0.13年,每QALY获得的成本为128,400美元.
- 较早的查 (35或45岁) 提供了更大的健康益处,但每QALY超过20万美元.
- 对于55岁的查,成本效益仍然有利,即使SGLT2抑制剂的有效性降低或药物价格降低.
结论:
- 在55岁时使用SGLT2抑制剂开始全民CKD查是基于传统医学基准的成本效益.
- 这一战略代表了改善CKD结果和有效管理医疗保健资源的可行方法.
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