Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
J Hypertens. 2013 Apr;31(4):782-90. doi: 10.1097/HJH.0b013e32835e8ee5.
Recently, it was demonstrated that information on carotid intima-media thickness (CIMT) and plaque may improve coronary heart disease (CHD) risk prediction through reclassification of some individuals to the correct risk category using the Framingham risk score. Our objective was to assess the currently unknown cost-effectiveness of CIMT measurements in primary prevention.
A hypothetical cohort of men and women aged 50-59 years and at intermediate or high CHD risk based on data from the Atherosclerosis Risk in Communities Study was simulated using a Markov model. Myocardial infarction (MI) events were used as a proxy for CHD. The effectiveness of pharmaceutical treatment was varied in the analysis. Sensitivity analysis was performed to obtain robust results.
CIMT-based reclassification induced a 1% lower absolute risk of MI and 0.01-0.02 increase in quality-adjusted life years (QALYs) for men, and a 1-3% lower risk, and 0.03-0.05 increase in QALYs for women, over a period of 20-30 years. Corresponding costs were an additional $100 per man, and a cost-saving of $200-300 per woman. Over a 10-year period CIMT measurements were cost-effective with a probability of 66% (men), and 94% (women). Over a 30-year period, CIMT measurements had acceptable cost-effectiveness for men and women.
Performing CIMT measurements in asymptomatic men and women aged 50-59 years results in additional, but small, health benefits. It takes time for these health benefits to outweigh the initial CIMT measurement costs. Our results support CIMT measurements for cardiovascular risk stratification, in particular for women, when focusing on long-term health.
最近的研究表明，颈动脉内膜中层厚度（CIMT）和斑块信息可以通过使用弗雷明汉风险评分将某些个体重新分类到正确的风险类别，从而改善冠心病（CHD）风险预测。我们的目的是评估颈动脉内膜中层厚度（CIMT）测量在一级预防中的未知成本效益。
使用基于社区动脉粥样硬化风险研究（Atherosclerosis Risk in Communities Study）数据的 50-59 岁男性和女性中间或高 CHD 风险的假设队列，使用马尔可夫模型进行模拟。心肌梗死（MI）事件被用作 CHD 的替代指标。在分析中，对药物治疗的有效性进行了不同的处理。进行了敏感性分析以获得稳健的结果。
基于 CIMT 的重新分类导致男性 MI 的绝对风险降低 1%，质量调整生命年（QALYs）增加 0.01-0.02，女性的风险降低 1-3%，QALYs 增加 0.03-0.05，在 20-30 年期间。相应的成本是每个男性增加 100 美元，每个女性节省 200-300 美元。在 10 年内，CIMT 测量具有成本效益，男性的概率为 66%，女性的概率为 94%。在 30 年内，CIMT 测量对男性和女性具有可接受的成本效益。
对 50-59 岁无症状男性和女性进行 CIMT 测量会带来额外的但较小的健康益处。这些健康益处需要时间才能超过初始 CIMT 测量的成本。当关注长期健康时，我们的结果支持 CIMT 测量用于心血管风险分层，特别是对女性而言。
