Lim Stephen S, Gaziano Thomas A, Gakidou Emmanuela, Reddy K Srinath, Farzadfar Farshad, Lozano Rafael, Rodgers Anthony
Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA 98102, USA.
Lancet. 2007 Dec 15;370(9604):2054-62. doi: 10.1016/S0140-6736(07)61699-7. Epub 2007 Dec 11.
In 2005, a global goal of reducing chronic disease death rates by an additional 2% per year was established. Scaling up coverage of evidence-based interventions to prevent cardiovascular disease in high-risk individuals in low-income and middle-income countries could play a major part in reaching this goal. We aimed to estimate the number of deaths that could be averted and the financial cost of scaling up, above current coverage levels, a multidrug regimen for prevention of cardiovascular disease (a statin, aspirin, and two blood-pressure-lowering medicines) in 23 such countries. Identification of individuals was limited to those already accessing health services, and treatment eligibility was based on the presence of existing cardiovascular disease or absolute risk of cardiovascular disease by use of easily measurable risk factors. Over a 10-year period, scaling up this multidrug regimen could avert 17.9 million deaths from cardiovascular disease (95% uncertainty interval 7.4 million-25.7 million). 56% of deaths averted would be in those younger than 70 years, with more deaths averted in women than in men owing to larger absolute numbers of women at older ages. The 10-year financial cost would be US$47 billion ($33 billion-$61 billion) or an average yearly cost per head of $1.08 ($0.75-1.40), ranging from $0.43 to $0.90 across low-income countries and from $0.54 to $2.93 across middle-income countries. This package could effectively meet three-quarters of the proposed global goal with a moderate increase in health expenditure.
2005年，制定了一项全球目标，即每年将慢性病死亡率再降低2%。扩大循证干预措施的覆盖范围，以预防低收入和中等收入国家高危人群的心血管疾病，对于实现这一目标可能发挥重要作用。我们旨在估计在23个此类国家中，扩大目前的覆盖水平，采用一种预防心血管疾病的多药联合治疗方案（一种他汀类药物、阿司匹林和两种降压药物），可以避免的死亡人数以及扩大规模所需的财务成本。个体的识别仅限于那些已经获得医疗服务的人群，治疗资格基于现有的心血管疾病或通过使用易于测量的风险因素得出的心血管疾病绝对风险。在10年期间，扩大这种多药联合治疗方案可以避免1790万人死于心血管疾病（95%不确定性区间为740万 - 2570万）。避免的死亡中有56%将发生在70岁以下人群中，由于老年女性的绝对数量更多，女性避免的死亡人数多于男性。10年的财务成本将为470亿美元（330亿 - 610亿美元），即人均每年成本为1.08美元（0.75 - 1.40美元），在低收入国家范围为0.43美元至0.90美元，在中等收入国家范围为0.54美元至2.93美元。通过适度增加卫生支出，这一方案可以有效实现拟议全球目标的四分之三。
