Grover S A, Coupal L, Paquet S, Zowall H
Centre for the Analysis of Cost-Effective Care, Montreal General Hospital, Department of Medicine, McGill University, Quebec.
Arch Intern Med. 1999 Mar 22;159(6):593-600. doi: 10.1001/archinte.159.6.593.
To forecast the long-term benefits and cost-effectiveness of lipid modification in the secondary prevention of cardiovascular disease.
A validated model based on data from the Lipid Research Clinics cohort was used to estimate the benefits and cost-effectiveness of lipid modification with 3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitors (statins) based on results from the Scandinavian Simvastatin Survival Study (4S), including a 35% decrease in low-density-lipoprotein (LDL)-cholesterol levels and an 8% increase in high-density-lipoprotein (HDL)-cholesterol levels. After comparing the short-term outcomes predicted for the 4S with the results actually observed, we forecast the long-term risk of recurrent myocardial infarction, congestive heart failure, transient ischemic attacks, arrhythmias, and strokes and the need for surgical procedures such as coronary artery bypass grafting, catheterization, angioplasty, and pacemaker insertions. Outpatient follow-up care costs were estimated, as were the costs of hospital care and drug therapy. All costs were expressed in 1996 US dollars.
The short-term outcomes predicted for the 4S were consistent with the observed results. The long-term benefits of lipid modification among low-risk subjects (normotensive nonsmokers) with a baseline LDL/ HDL ratio of 5 but no other risk factors ranged from $5424 to $9548 per year of life saved for men and $8389 to $13747 per year of life saved for women. In high-risk subjects (hypertensive smokers) with an LDL/HDL ratio of 5, the estimated costs ranged from $4487 to $8532 per year of life saved in men and $5138 to $8389 per year of life saved in women. Assuming that lipid modification has no effect on the risk of stroke, cost-effectiveness increased by as much as 100%.
These long-term cost estimates are consistent with the short-term economic analyses of the published 4S results. The long-term treatment of hyperlipidemia in secondary prevention is forecasted to be cost-effective across a broad range of patients between 40 and 70 years of age. Recognizing the additional effects of lipid changes on cerebrovascular events can substantially improve the cost-effectiveness of treating hyperlipidemia.
预测心血管疾病二级预防中脂质修饰的长期益处和成本效益。
基于脂质研究诊所队列数据的经过验证的模型，用于根据斯堪的纳维亚辛伐他汀生存研究（4S）的结果，估计使用3-羟基-3-甲基戊二酰辅酶A还原酶抑制剂（他汀类药物）进行脂质修饰的益处和成本效益，包括低密度脂蛋白（LDL）胆固醇水平降低35%和高密度脂蛋白（HDL）胆固醇水平升高8%。在将4S预测的短期结果与实际观察结果进行比较后，我们预测了复发性心肌梗死、充血性心力衰竭、短暂性脑缺血发作、心律失常和中风的长期风险，以及冠状动脉搭桥术、导管插入术、血管成形术和起搏器植入等外科手术的需求。估计了门诊随访护理成本以及住院护理和药物治疗成本。所有成本均以1996年美元表示。
4S预测的短期结果与观察结果一致。对于基线LDL/HDL比值为5但无其他危险因素的低风险受试者（血压正常的非吸烟者），脂质修饰的长期益处为男性每挽救一年生命的成本在5424美元至9548美元之间，女性为每挽救一年生命的成本在8389美元至13747美元之间。对于LDL/HDL比值为5的高风险受试者（高血压吸烟者），估计男性每挽救一年生命的成本在4487美元至8532美元之间，女性为每挽救一年生命的成本在5138美元至8389美元之间。假设脂质修饰对中风风险无影响，成本效益可提高多达100%。
这些长期成本估计与已发表的4S结果的短期经济分析一致。预计在40至70岁的广泛患者中，二级预防中高脂血症的长期治疗具有成本效益。认识到脂质变化对脑血管事件的额外影响可显著提高治疗高脂血症的成本效益。
