Thomas Chloe, Brennan Alan, Goka Edward, Squires Hazel Y, Brenner Gilly, Bagguley David, Buckley Woods Helen, Gillett Michael, Leaviss Joanna, Clowes Mark, Heathcote Laura, Cooper Katy, Breeze Penny
School of Health & Related Research, University of Sheffield, Sheffield, UK
School of Health & Related Research, University of Sheffield, Sheffield, UK.
BMJ Open. 2020 Sep 10;10(9):e037486. doi: 10.1136/bmjopen-2020-037486.
To estimate the cost savings and health benefits of improving detection of individuals at high risk of cardiovascular disease (CVD) in England, to determine to which patient subgroups these benefits arise, and to compare different strategies for subsequent management.
An economic analysis using the School for Public Health Research CVD Prevention Model.
England 2018.
Adults aged 16 and older with one or more high cardiovascular risk conditions, including hypertension, diabetes, non-diabetic hyperglycaemia, atrial fibrillation, chronic kidney disease and high cholesterol.
Detection of 100% of individuals with CVD high risk conditions compared with current levels of detection in England. Detected individuals are assumed to be managed either according to current levels of care or National Institute of Health and Care Excellence (NICE) guidelines.
Incremental and cumulative costs, savings, quality adjusted life years (QALYs), CVD cases, and net monetary benefit, from a UK NHS and Personal Social Services perspective.
£68 billion could be saved, 4.9 million QALYs gained and 3.4 million cases of CVD prevented over 25 years if all individuals in England with the six CVD high risk conditions were diagnosed and subsequently managed at current levels. Additionally, if all detected individuals were managed according to NICE guidelines, total savings would be £61 billion, 8.1 million QALYs would be gained and 5.2 million CVD cases prevented. Most benefits come from detection of high cholesterol in the short term and diabetes in the long term.
Substantial cost savings and health benefits would accrue if all individuals with conditions that increase CVD risk could be diagnosed, with detection of undiagnosed diabetes producing greatest benefits. Ensuring all conditions are managed according to NICE guidelines would further increase health benefits. Projected cost-savings could be invested in developing acceptable and cost-effective solutions for improving detection and management.
评估在英格兰改善心血管疾病（CVD）高危个体检测所带来的成本节约和健康效益，确定这些效益产生于哪些患者亚组，并比较后续管理的不同策略。
使用公共卫生研究学院的心血管疾病预防模型进行经济分析。
2018年的英格兰。
16岁及以上患有一种或多种心血管高危疾病的成年人，包括高血压、糖尿病、非糖尿病性高血糖、心房颤动、慢性肾脏病和高胆固醇。
与英格兰当前的检测水平相比，对100%患有心血管疾病高危疾病的个体进行检测。假定对检测出的个体按照当前的护理水平或英国国家卫生与临床优化研究所（NICE）的指南进行管理。
从英国国民医疗服务体系（NHS）和个人社会服务的角度来看，增量成本和累积成本、节约的费用、质量调整生命年（QALYs）、心血管疾病病例数以及净货币效益。
如果英格兰所有患有六种心血管疾病高危疾病的个体都能被诊断出来并随后按照当前水平进行管理，那么在25年内可节省680亿英镑，获得490万个质量调整生命年，并预防340万例心血管疾病。此外，如果所有检测出的个体都按照NICE指南进行管理，总节约费用将为610亿英镑，将获得810万个质量调整生命年，并预防520万例心血管疾病。大多数效益在短期内来自高胆固醇的检测，长期内来自糖尿病的检测。
如果所有患有增加心血管疾病风险疾病的个体都能被诊断出来，将会带来可观的成本节约和健康效益，未诊断出的糖尿病的检测产生的效益最大。确保所有疾病都按照NICE指南进行管理将进一步提高健康效益。预计节省的成本可用于投资开发可接受且具有成本效益的解决方案，以改善检测和管理。
