Goldman L, Sia S T, Cook E F, Rutherford J D, Weinstein M C
Division of Clinical Epidemiology, Brigham and Women's Hospital, Boston, MA 02115.
N Engl J Med. 1988 Jul 21;319(3):152-7. doi: 10.1056/NEJM198807213190306.
We analyzed the costs and effectiveness of routine therapy with beta-adrenergic antagonists in patients who survived an acute myocardial infarction. On the basis of data pooled from the literature, this form of therapy resulted in a 25 percent relative reduction annually in the mortality rate for years 1 to 3 and a 7 percent relative reduction for years 4 to 6 after a myocardial infarction. The estimated cost of six years of routine beta-adrenergic-antagonist therapy to save an additional year of life was $23,400 in low-risk patients, $5,900 in medium-risk patients, and $3,600 in high-risk patients, assuming that the entire benefit of earlier treatment is lost immediately after six years. Under a more likely assumption--that the benefit of six years of treatment wears off gradually over the subsequent nine years--the estimated cost of therapy per year of life saved would be $13,000 in low-risk patients, $3,600 in medium-risk patients, and $2,400 in high-risk patients. As compared with coronary-artery bypass grafting and the medical treatment of hypertension, routine beta-adrenergic-antagonist therapy has a relatively favorable cost-effectiveness ratio.
我们分析了β-肾上腺素能拮抗剂常规治疗对急性心肌梗死后存活患者的成本和效果。根据文献汇总的数据，这种治疗方式在心肌梗死后1至3年使死亡率每年相对降低25%，4至6年使死亡率相对降低7%。假设六年的早期治疗全部益处会在六年后立即消失，那么对于低风险患者，采用β-肾上腺素能拮抗剂常规治疗六年以多挽救一年生命的估计成本为23,400美元，中风险患者为5,900美元，高风险患者为3,600美元。在一个更有可能的假设下——即六年治疗的益处会在随后九年中逐渐消失——那么低风险患者每挽救一年生命的治疗估计成本为13,000美元，中风险患者为3,600美元，高风险患者为2,400美元。与冠状动脉搭桥术和高血压药物治疗相比，β-肾上腺素能拮抗剂常规治疗具有相对有利的成本效益比。
