Health Economics Unit, Public Health Building, University of Birmingham, Birmingham B15 2TT, UK.
BMJ. 2011 Jul 28;343:d4044. doi: 10.1136/bmj.d4044.
To estimate the potential cost effectiveness of a population-wide risk factor reduction programme aimed at preventing cardiovascular disease.
Economic modelling analysis.
England and Wales. Population Entire population. Model Spreadsheet model to quantify the reduction in cardiovascular disease over a decade, assuming the benefits apply consistently for men and women across age and risk groups.
Cardiovascular events avoided, quality adjusted life years gained, and savings in healthcare costs for a given effectiveness; estimates of how much it would be worth spending to achieve a specific outcome.
A programme across the entire population of England and Wales (about 50 million people) that reduced cardiovascular events by just 1% would result in savings to the health service worth at least £30m (€34m; $48m) a year compared with no additional intervention. Reducing mean cholesterol concentrations or blood pressure levels in the population by 5% (as already achieved by similar interventions in some other countries) would result in annual savings worth at least £80m to £100m. Legislation or other measures to reduce dietary salt intake by 3 g/day (current mean intake approximately 8.5 g/day) would prevent approximately 30,000 cardiovascular events, with savings worth at least £40m a year. Legislation to reduce intake of industrial trans fatty acid by approximately 0.5% of total energy content might gain around 570,000 life years and generate NHS savings worth at least £230m a year.
Any intervention that achieved even a modest population-wide reduction in any major cardiovascular risk factor would produce a net cost saving to the NHS, as well as improving health. Given the conservative assumptions used in this model, the true benefits would probably be greater.
评估一项旨在预防心血管疾病的全人群危险因素降低计划的潜在成本效益。
经济建模分析。
英格兰和威尔士。人群：整个人群。模型：使用电子表格模型来量化十年内心血管疾病的减少量，假设该计划对不同年龄和风险组别的男性和女性都具有一致的益处。
避免的心血管事件、获得的质量调整生命年以及特定效果的成本节约；实现特定结果的成本效益估计。
在英格兰和威尔士（约 5000 万人）开展一项覆盖整个人群的计划，即使仅降低 1%的心血管事件，与不进行额外干预相比，每年也将为医疗服务节省至少 3000 万英镑（3400 万欧元；4800 万美元）。将人群的平均胆固醇浓度或血压水平降低 5%（已经在其他一些国家实施的类似干预措施已经实现了这一目标），每年将节省至少 8000 万至 1 亿英镑。通过立法或其他措施将每日盐摄入量减少 3 克（目前的平均摄入量约为 8.5 克/天），将预防约 3 万例心血管事件，每年可节省至少 4000 万英镑。立法将工业反式脂肪酸摄入量减少约 0.5%总能量含量，可能会增加约 57 万生命年，并为国民保健制度节省每年至少 2.3 亿英镑的费用。
任何实现全人群主要心血管危险因素适度降低的干预措施都将为国民保健制度带来净成本节约，并改善健康状况。鉴于该模型使用了保守的假设，实际效益可能更大。
