Aljutaili Majed, Becker Christian, Witt Sabine, Holle Rolf, Leidl Reiner, Block Michael, Brachmann Johannes, Silber Sigmund, Bestehorn Kurt, Stollenwerk Björn
Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Institute of Health Economics and Health Care Management, Ingolstädter Landstr, 1, 85764 Neuherberg, Germany.
BMC Health Serv Res. 2014 Jun 17;14:263. doi: 10.1186/1472-6963-14-263.
Cardiovascular diseases are the main cause of death worldwide, making their prevention a major health care challenge. In 2006, a German statutory health insurance company presented a novel individualised prevention programme (KardioPro), which focused on coronary heart disease (CHD) screening, risk factor assessment, early detection and secondary prevention. This study evaluates KardioPro in CHD risk subgroups, and analyses the cost-effectiveness of different individualised prevention strategies.
The CHD risk subgroups were assembled based on routine data from the statutory health insurance company, making use of a quasi-beta regression model for risk prediction. The control group was selected via propensity score matching based on logistic regression and an approximate nearest neighbour approach. The main outcome was cost-effectiveness. Effectiveness was measured as event-free time, and events were defined as myocardial infarction, stroke and death. Incremental cost-effectiveness ratios comparing participants with non-participants were calculated for each subgroup. To assess the uncertainty of results, a bootstrapping approach was applied.
The cost-effectiveness of KardioPro in the group at high risk of CHD was € 20,901 per event-free year; in the medium-risk group, € 52,323 per event-free year; in the low-risk group, € 186,074 per event-free year; and in the group with known CHD, € 26,456 per event-free year. KardioPro was associated with a significant health gain but also a significant cost increase. However, statistical significance could not be shown for all subgroups.
The cost-effectiveness of KardioPro differs substantially according to the group being targeted. Depending on the willingness-to-pay, it may be reasonable to only offer KardioPro to patients at high risk of further cardiovascular events. This high-risk group could be identified from routine statutory health insurance data. However, the long-term consequences of KardioPro still need to be evaluated.
心血管疾病是全球主要死因，其预防是一项重大的医疗保健挑战。2006年，一家德国法定健康保险公司推出了一项新颖的个性化预防计划（KardioPro），该计划侧重于冠心病（CHD）筛查、风险因素评估、早期检测和二级预防。本研究评估了KardioPro在冠心病风险亚组中的效果，并分析了不同个性化预防策略的成本效益。
基于法定健康保险公司的常规数据，利用准贝塔回归模型进行风险预测，组建冠心病风险亚组。通过基于逻辑回归和近似最近邻方法的倾向得分匹配选择对照组。主要结果是成本效益。有效性以无事件时间衡量，事件定义为心肌梗死、中风和死亡。计算每个亚组中参与者与非参与者的增量成本效益比。为评估结果的不确定性，采用了自举法。
KardioPro在冠心病高风险组中每无事件年的成本效益为20,901欧元；在中风险组中，每无事件年为52,323欧元；在低风险组中，每无事件年为186,074欧元；在已知冠心病组中，每无事件年为26,456欧元。KardioPro与显著的健康获益相关，但也伴随着显著的成本增加。然而，并非所有亚组都具有统计学显著性。
KardioPro的成本效益因目标群体的不同而有很大差异。根据支付意愿，仅向有进一步心血管事件高风险的患者提供KardioPro可能是合理的。这个高风险群体可以从法定健康保险常规数据中识别出来。然而，KardioPro的长期后果仍需评估。
