Fidan D, Unal B, Critchley J, Capewell S
Department of Public Health, University of Liverpool, Whelan Building, Quadrangle, Liverpool L69 3GB, UK.
QJM. 2007 May;100(5):277-89. doi: 10.1093/qjmed/hcm020. Epub 2007 Apr 21.
Coronary heart disease (CHD) in the UK affects approximately 3 million people, with >100,000 deaths annually. Mortality rates have halved since the 1980s, but annual NHS treatment costs for CHD exceed 2 billion pounds.
To examine the cost-effectiveness of specific CHD treatments in England and Wales.
The IMPACT CHD model was used to calculate the number of life-years gained (LYG) from specific cardiological interventions from 2000 to 2010. Cost-effectiveness ratios (costs per LYG) were generated for each specific intervention, stratified by age and sex. The robustness of the results was tested using sensitivity analyses.
In 2000, medical and surgical treatments together prevented or postponed approximately 25,888 deaths in CHD patients aged 25-84 years, thus generating approximately 194,929 extra life-years between 2000 and 2010 (range 143,131-260,167). Aspirin and beta-blockers for secondary prevention following myocardial infarction or revascularisation, for angina and heart failure were highly cost-effective (< 1000 pounds per LYG). Other secondary prevention therapies, including cardiac rehabilitation, ACE inhibitors and statins, were reasonably cost-effective (1957 pounds, 3398 pounds and 4246 pounds per LYG, respectively), as were CABG surgery (3239 pounds-4601 pounds per LYG) and angioplasty (3845 pounds-5889 pounds per LYG). Primary angioplasty for myocardial infarction was intermediate (6054 pounds-12,057 pounds per LYG, according to age), and statins in primary prevention were much less cost-effective (27,828 pounds per LYG, reaching 69,373 pounds per LYG in men aged 35-44). Results were relatively consistent across a wide range of sensitivity analyses.
The cost-effectiveness ratios for standard CHD treatments varied by over 100-fold. Large amounts of NHS funding are being spent on relatively less cost-effective interventions, such as statins for primary prevention, angioplasty and CABG surgery. This merits debate.
在英国，冠心病（CHD）影响着约300万人，每年有超过10万人死亡。自20世纪80年代以来，死亡率已减半，但英国国家医疗服务体系（NHS）每年用于冠心病的治疗费用超过20亿英镑。
研究英格兰和威尔士特定冠心病治疗方法的成本效益。
使用IMPACT CHD模型计算2000年至2010年特定心脏干预措施所获得的生命年数（LYG）。针对每种特定干预措施，按年龄和性别分层生成成本效益比（每生命年的成本）。通过敏感性分析测试结果的稳健性。
2000年，药物治疗和手术治疗共同预防或推迟了25888例25至84岁冠心病患者的死亡，从而在2000年至2010年间产生了约194929个额外的生命年（范围为143131至260167）。心肌梗死或血运重建、心绞痛和心力衰竭后用于二级预防的阿司匹林和β受体阻滞剂具有很高的成本效益（每生命年<1000英镑）。其他二级预防疗法，包括心脏康复、血管紧张素转换酶（ACE）抑制剂和他汀类药物，成本效益合理（分别为每生命年1957英镑、3398英镑和4246英镑），冠状动脉搭桥术（CABG）手术（每生命年3239英镑至4601英镑）和血管成形术（每生命年3845英镑至5889英镑）也是如此。心肌梗死的直接血管成形术成本效益中等（根据年龄，每生命年6054英镑至12057英镑），一级预防中的他汀类药物成本效益则低得多（每生命年27828英镑，在35至44岁男性中达到每生命年69373英镑）。在广泛的敏感性分析中，结果相对一致。
标准冠心病治疗的成本效益比相差超过100倍。大量的NHS资金被用于成本效益相对较低的干预措施，如一级预防中的他汀类药物、血管成形术和CABG手术。这值得探讨。
