Dalziel Kim, Segal Leonie, de Lorgeril Michel
Nutrition, Vieillissement et Maladies Cardiovasculaires (NVMCV), UFR de Médecine, Domaine de la Merci 38056 La Tronche, France.
J Nutr. 2006 Jul;136(7):1879-85. doi: 10.1093/jn/136.7.1879.
This evaluation aimed to assess the economic performance of the Mediterranean diet for patients after a first acute myocardial infarction (AMI). A cost utility analysis using a Markov model was used to compare the Mediterranean diet to a prudent Western diet over a time frame of 10 years. After a systematic review of the literature, program effectiveness was based on the Lyon Diet Heart Study (605 patients, mean age 54 y, randomized to the Mediterranean diet delivered by a dietician and cardiologist, or a prudent Western diet). Costs were estimated in AU$ [and converted to US$ and Euros (euro)] based on the resource use to which published unit costs were applied. Cost and benefits were discounted at 5% per annum. The main outcome measure was cost per quality-adjusted life year (QALY) gained. Extensive 1-way sensitivity analyses were performed. The Mediterranean diet compared with a prudent Western diet was estimated to cost AU$1013 (US$703, euro579) per QALY gained per person. There was a mean gain in life years of 0.31/person and a gain in quality-adjusted life years of 0.40/person. Based on the published results from the Lyon Diet Heart Study and conservative assumptions, the Mediterranean diet is highly cost-effective for persons after a first AMI and represents an exceptional return on investment. Policy makers should strongly consider the generalizability of results to their own setting.
本评估旨在评估地中海饮食对首次急性心肌梗死(AMI)后患者的经济表现。采用马尔可夫模型进行成本效用分析,以比较地中海饮食与谨慎的西方饮食在10年时间范围内的情况。在对文献进行系统回顾后,项目有效性基于里昂饮食心脏研究(605名患者,平均年龄54岁,随机分为由营养师和心脏病专家提供的地中海饮食组,或谨慎的西方饮食组)。根据应用已发表单位成本的资源使用情况,以澳元估算成本[并换算为美元和欧元(欧元)]。成本和效益按每年5%进行贴现。主要结局指标是每获得一个质量调整生命年(QALY)的成本。进行了广泛的单因素敏感性分析。与谨慎的西方饮食相比,地中海饮食估计每人每获得一个QALY的成本为1013澳元(703美元,579欧元)。人均生命年平均增加0.31,质量调整生命年增加0.40。根据里昂饮食心脏研究发表的结果和保守假设,地中海饮食对首次发生AMI后的患者具有很高的成本效益,代表了卓越的投资回报率。政策制定者应强烈考虑将结果推广到自身环境的可行性。