Section of Value and Comparative Effectiveness, Division of General Internal Medicine, NYU School of Medicine, 423 E 23rd Street, New York, NY 10010, USA.
Am J Manag Care. 2011 Jun;17(6):431-8.
To identify cardiovascular health services with a high level of evidence to suggest that they deliver favorable value.
Evidence synthesis using the Cost-Effectiveness Analysis Registry.
We queried the registry to identify published cost-effectiveness analyses of cardiovascular health services in the United States. In addition to searching the registry, we performed supplementary searches of published literature for cost-effectiveness studies of cardiovascular interventions that were endorsed by guidelines of national medical and scientific societies. We defined favorable value as an incremental cost-effectiveness ratio of $100,000 or less per quality-adjusted life-year.
Our initial review of cardiovascular health services in the United States revealed 174 separate peer-reviewed studies. Of those, 157 studies did not meet our inclusion criteria, leaving 17 studies for further evaluation that covered the following services with potentially high value: statins to prevent myocardial infarction (for primary and secondary prevention), screening for and treatment of high blood pressure (diuretics or beta-blockers and angiotensin-converting enzyme inhibitors in the case of diabetes) to prevent myocardial infarction and stroke, warfarin sodium and low-molecular-weight heparin to prevent pulmonary emboli, implantable cardiac defibrillators for patients at high risk of sudden death, antiplatelet drugs (aspirin and clopidogrel bisulfate) to prevent future myocardial infarction, beta-blockers for patients who have had myocardial infarction, warfarin to prevent future stroke in persons with nonvalvular atrial fibrillation, and percutaneous procedures to relieve claudication symptoms.
We describe a new way of synthesizing cost-effectiveness evidence for use by consumers, payers, and other decision makers.
确定具有高水平证据表明能提供有利价值的心血管健康服务。
使用成本效益分析登记处进行证据综合。
我们在登记处查询，以确定美国心血管健康服务的已发表成本效益分析。除了在登记处进行搜索外，我们还对心血管干预措施的成本效益研究进行了补充文献搜索，这些研究得到了国家医学和科学协会指南的认可。我们将有利价值定义为每增加一个质量调整生命年的增量成本效益比为 100000 美元或更低。
我们对美国心血管健康服务的初步审查显示了 174 项独立的同行评议研究。其中，157 项研究不符合我们的纳入标准，留下 17 项研究进行进一步评估，涵盖了以下具有潜在高价值的服务：他汀类药物预防心肌梗死（用于一级和二级预防）、高血压筛查和治疗（利尿剂或β受体阻滞剂和血管紧张素转换酶抑制剂用于糖尿病）预防心肌梗死和中风、华法林钠和低分子量肝素预防肺栓塞、植入式心脏除颤器用于高猝死风险患者、抗血小板药物（阿司匹林和氯吡格雷双硫酸盐）预防未来心肌梗死、β受体阻滞剂用于心肌梗死后患者、华法林预防非瓣膜性心房颤动患者未来中风、以及经皮手术缓解跛行症状。
我们描述了一种综合成本效益证据的新方法，供消费者、支付者和其他决策者使用。
