Yale School of Public Health, New Haven, United States of America.
Bull World Health Organ. 2011 Apr 1;89(4):286-95. doi: 10.2471/BLT.10.082370. Epub 2011 Feb 17.
To assess the prevalence of cardiovascular (CV) risk factors in Seychelles, a middle-income African country, and compare the cost-effectiveness of single-risk-factor management (treating individuals with arterial blood pressure ≥ 140/90 mmHg and/or total serum cholesterol ≥ 6.2 mmol/l) with that of management based on total CV risk (treating individuals with a total CV risk ≥ 10% or ≥ 20%).
CV risk factor prevalence and a CV risk prediction chart for Africa were used to estimate the 10-year risk of suffering a fatal or non-fatal CV event among individuals aged 40-64 years. These figures were used to compare single-risk-factor management with total risk management in terms of the number of people requiring treatment to avert one CV event and the number of events potentially averted over 10 years. Treatment for patients with high total CV risk (≥ 20%) was assumed to consist of a fixed-dose combination of several drugs (polypill). Cost analyses were limited to medication.
A total CV risk of ≥ 10% and ≥ 20% was found among 10.8% and 5.1% of individuals, respectively. With single-risk-factor management, 60% of adults would need to be treated and 157 cardiovascular events per 100000 population would be averted per year, as opposed to 5% of adults and 92 events with total CV risk management. Management based on high total CV risk optimizes the balance between the number requiring treatment and the number of CV events averted.
Total CV risk management is much more cost-effective than single-risk-factor management. These findings are relevant for all countries, but especially for those economically and demographically similar to Seychelles.
评估塞舌尔（一个中等收入的非洲国家）心血管（CV）危险因素的流行情况，并比较单一危险因素管理（治疗动脉血压≥140/90mmHg 和/或总血清胆固醇≥6.2mmol/L 的个体）与基于总 CV 风险的管理（治疗总 CV 风险≥10%或≥20%的个体）的成本效益。
使用 CV 危险因素流行情况和非洲 CV 风险预测图来估计 40-64 岁人群中发生致命或非致命 CV 事件的 10 年风险。这些数据用于比较单一危险因素管理与总风险管理在需要治疗以避免一次 CV 事件的人数和 10 年内可能避免的事件数量方面的效果。对于高总 CV 风险（≥20%）的患者，假定治疗包括几种药物（复合药物）的固定剂量联合。成本分析仅限于药物治疗。
分别有 10.8%和 5.1%的个体存在总 CV 风险≥10%和≥20%。采用单一危险因素管理，需要治疗的成年人比例为 60%，每年每 10 万人可避免 157 例心血管事件，而采用总 CV 风险管理，需要治疗的成年人比例为 5%，可避免 92 例心血管事件。基于高总 CV 风险的管理优化了需要治疗的人数和可避免的 CV 事件数量之间的平衡。
总 CV 风险管理比单一危险因素管理更具成本效益。这些发现与所有国家都有关，但与那些在经济和人口方面与塞舌尔相似的国家尤为相关。
