Morris S, McGuire A, Caro J, Pettitt D
Department of Economics, City University, London, UK.
J Health Serv Res Policy. 1997 Oct;2(4):231-50. doi: 10.1177/135581969700200408.
To review research addressing the management of cholesterol in the prevention of coronary heart disease in order to assess the cost-effectiveness of such interventions.
A systematic review of economic evaluations identified through searches of MEDLINE and the Social Sciences Citation Index revealed 38 studies addressing the cost-effectiveness of cholesterol management. They were distinguished according to screening approaches, dietary advice and drug treatment. Most studies were not associated directly with clinical trial results, but adopted economic modelling approaches.
Whilst there is general agreement among the majority of analyses, studies of cholesterol management concerned with screening strategies were extremely sensitive to changes in their assumptions; so much so that only a limited emphasis may be placed on specific cost-effectiveness ratios and the conclusions drawn from them. All studies considered direct costs, though many were limited to drug costs. The cost-effectiveness of primary prevention by cholesterol-lowering drugs is highly variable, depending on age at initiation of treatment and cardiovascular risk profile. Pharmacological intervention is least cost-effective in the young and the elderly. The cost-effectiveness of cholesterol-reducing agents improves when they are targeted at those at high risk. HMG-CoA reductase inhibitors are generally more effective and more cost-effective at reducing cholesterol-related coronary events than other medications.
The methods and economic data upon which these studies are based need to be improved if robust policy conclusions are to be formulated.
回顾关于胆固醇管理在预防冠心病方面的研究，以评估此类干预措施的成本效益。
通过检索MEDLINE和社会科学引文索引对经济评估进行系统回顾，共发现38项关于胆固醇管理成本效益的研究。这些研究根据筛查方法、饮食建议和药物治疗进行区分。大多数研究并非直接与临床试验结果相关，而是采用经济建模方法。
虽然大多数分析意见基本一致，但涉及筛查策略的胆固醇管理研究对其假设的变化极为敏感；以至于对特定的成本效益比及其得出的结论只能给予有限的重视。所有研究都考虑了直接成本，不过许多研究仅限于药物成本。通过降低胆固醇药物进行一级预防的成本效益差异很大，这取决于开始治疗时的年龄和心血管风险状况。药物干预在年轻人和老年人中成本效益最低。当针对高危人群时，降低胆固醇药物的成本效益会提高。与其他药物相比，HMG-CoA还原酶抑制剂在降低胆固醇相关冠心病事件方面通常更有效且更具成本效益。
如果要得出可靠的政策结论，这些研究所依据的方法和经济数据需要改进。
