Dehmer Steven P, Maciosek Michael V, LaFrance Amy B, Flottemesch Thomas J
HealthPartners Institute, Minneapolis, Minnesota
HealthPartners Institute, Minneapolis, Minnesota.
Ann Fam Med. 2017 Jan;15(1):23-36. doi: 10.1370/afm.2015. Epub 2017 Jan 6.
Our aim was to update estimates of the health and economic impact of clinical services recommended for the primary prevention of cardiovascular disease (CVD) for the comparative rankings of the National Commission on Prevention Priorities, and to explore differences in outcomes by sex and race/ethnicity.
We used a single, integrated, microsimulation model to generate comparable results for 3 services recommended by the US Preventive Services Task Force: aspirin counseling for the primary prevention of CVD and colorectal cancer, screening and treatment for lipid disorders (usually high cholesterol), and screening and treatment for hypertension. Analyses compare lifetime outcomes from the societal perspective for a US-representative birth cohort of 100,000 persons with and without access to each clinical preventive service. Primary outcomes are health impact, measured by the net difference in lifetime quality-adjusted life years (QALYs), and cost-effectiveness, measured in incremental cost per QALY or cost savings per person in 2012 dollars. Results are also presented for population subgroups defined by sex and race/ethnicity.
Health impact is highest for hypertension screening and treatment (15,600 QALYs), but is closely followed by cholesterol screening and treatment (14,300 QALYs). Aspirin counseling has a lower health impact (2,200 QALYs) but is found to be cost saving ($31 saved per person). Cost-effectiveness for cholesterol and hypertension screening and treatment is $33,800 per QALY and $48,500 per QALY, respectively. Findings favor hypertension over cholesterol screening and treatment for women, and opportunities to reduce disease burden across all services are greatest for the non-Hispanic black population.
All 3 CVD preventive services continue to rank highly among other recommended preventive services for US adults, but individual priorities can be tailored in practice by taking a patient's demographic characteristics and clinical objectives into account.
我们的目标是更新针对心血管疾病（CVD）一级预防所推荐临床服务的健康和经济影响评估，以用于预防重点全国委员会的比较排名，并探讨按性别和种族/族裔划分的结果差异。
我们使用单一的综合微观模拟模型，为美国预防服务工作组推荐的3项服务生成可比结果：用于CVD和结直肠癌一级预防的阿司匹林咨询、脂质紊乱（通常为高胆固醇）的筛查和治疗，以及高血压的筛查和治疗。分析从社会角度比较了具有和不具有每项临床预防服务的100,000名美国代表性出生队列人群的终生结果。主要结果是健康影响，通过终生质量调整生命年（QALY）的净差异来衡量，以及成本效益，以每QALY的增量成本或按2012年美元计算的每人成本节省来衡量。还给出了按性别和种族/族裔定义的人群亚组的结果。
高血压筛查和治疗的健康影响最大（15,600个QALY），但紧随其后的是胆固醇筛查和治疗（14,300个QALY）。阿司匹林咨询的健康影响较低（2,200个QALY），但被发现具有成本节省效益（每人节省31美元）。胆固醇和高血压筛查及治疗的成本效益分别为每QALY 33,800美元和每QALY 48,500美元。研究结果表明，对于女性而言，高血压筛查和治疗优于胆固醇筛查和治疗，并且所有服务中减少疾病负担的机会对于非西班牙裔黑人人群最大。
所有这3项CVD预防服务在美国成年人的其他推荐预防服务中仍然排名很高，但在实践中可以通过考虑患者的人口统计学特征和临床目标来调整个人优先事项。
