Chew Derek P, Carter Robert, Rankin Bree, Boyden Andrew, Egan Helen
Flinders Medical Centre, Flinders University, Flinders Drive, Bedford Park, SA 5042, Australia.
Aust Health Rev. 2010 May;34(2):162-9. doi: 10.1071/AH09742.
The cost effectiveness of a general practice-based program for managing coronary heart disease (CHD) patients in Australia remains uncertain. We have explored this through an economic model.
A secondary prevention program based on initial clinical assessment and 3 monthly review, optimising of pharmacotherapies and lifestyle modification, supported by a disease registry and financial incentives for quality of care and outcomes achieved was assessed in terms of incremental cost effectiveness ratio (ICER), in Australian dollars per disability adjusted life year (DALY) prevented.
Based on 2006 estimates, 263 487 DALYs were attributable to CHD in Australia. The proposed program would add $115 650 000 to the annual national heath expenditure. Using an estimated 15% reduction in death and disability and a 40% estimated program uptake, the program's ICER is $8081 per DALY prevented. With more conservative estimates of effectiveness and uptake, estimates of up to $38 316 per DALY are observed in sensitivity analysis.
Although innovation in CHD management promises improved future patient outcomes, many therapies and strategies proven to reduce morbidity and mortality are available today. A general practice-based program for the optimal application of current therapies is likely to be cost-effective and provide substantial and sustainable benefits to the Australian community.
在澳大利亚，基于全科医疗的冠心病（CHD）患者管理项目的成本效益仍不明确。我们通过一个经济模型对此进行了探究。
对一个二级预防项目进行评估，该项目基于初始临床评估和每3个月一次的复查，优化药物治疗和生活方式改变，并由疾病登记系统提供支持，同时对医疗质量和所取得的成果给予经济激励，评估指标为增量成本效益比（ICER），以澳元为单位，每预防一个伤残调整生命年（DALY）所需的成本。
根据2006年的估计，澳大利亚有263487个DALY可归因于冠心病。拟议的项目将使国家年度卫生支出增加1.1565亿澳元。假设死亡和残疾人数减少15%，且项目采用率估计为40%，该项目的ICER为每预防一个DALY需8081澳元。在敏感性分析中，若对有效性和采用率进行更保守的估计，每DALY的成本估计高达38316澳元。
尽管冠心病管理方面的创新有望改善未来患者的治疗效果，但目前已有许多经证实可降低发病率和死亡率的治疗方法和策略。一个基于全科医疗的项目，用于优化当前治疗方法的应用，可能具有成本效益，并为澳大利亚社区带来重大且可持续的益处。
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