Khushalani Jaya S, Song Suhang, Calhoun Brian H, Puddy Richard W, Kucik James E
Office of the Associate Director for Policy and Strategy, Centers for Disease Control and Prevention, Atlanta, Georgia.
Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee.
Am J Prev Med. 2022 Feb;62(2):275-284. doi: 10.1016/j.amepre.2021.07.019. Epub 2021 Nov 1.
Heart disease, cancer, unintentional injury, chronic lower respiratory disease, and stroke are the 5 leading causes of death in the U.S. The objective of this review is to examine the economic value of prevention interventions addressing these 5 conditions.
Tufts Medical Center Cost-Effectiveness Analysis Registry data were queried from 2010 to 2018 for interventions that addressed any of the 5 conditions in the U.S. Results were stratified by condition, prevention stage, type of intervention, study sponsorship, and study perspective. The analyses were conducted in 2020, and all costs were reported in 2019 dollars.
In total, 549 cost-effectiveness analysis studies examined interventions addressing these 5 conditions in the U.S. Tertiary prevention interventions were assessed in 61.4%, whereas primary prevention was assessed in 8.6% of the studies. Primary prevention studies were predominantly funded by government, whereas industry sources funded more tertiary prevention studies, especially those dealing with pharmaceutical interventions. The median incremental cost-effectiveness ratio for the 5 conditions combined was $68,500 per quality-adjusted life year. Median incremental cost-effectiveness ratios were lowest for primary prevention and highest for tertiary prevention.
Primary prevention may be more cost effective than secondary and tertiary prevention interventions; however, research investments in primary prevention interventions, especially by industry, lag in comparison. These findings help to highlight the gaps in the cost-effectiveness analysis literature related to the 5 leading causes of death and identify understudied interventions and prevention stages for each condition.
心脏病、癌症、意外伤害、慢性下呼吸道疾病和中风是美国的五大主要死因。本综述的目的是研究针对这五种疾病的预防干预措施的经济价值。
查询了塔夫茨医学中心成本效益分析登记处2010年至2018年期间针对美国这五种疾病中任何一种的干预措施的数据。结果按疾病、预防阶段、干预类型、研究资助方和研究视角进行了分层。分析于2020年进行，所有成本均以2019年美元报告。
总共549项成本效益分析研究考察了美国针对这五种疾病的干预措施。61.4%的研究评估了三级预防干预措施，而8.6%的研究评估了一级预防措施。一级预防研究主要由政府资助，而行业来源资助了更多的三级预防研究，尤其是那些涉及药物干预的研究。这五种疾病综合起来的中位增量成本效益比为每质量调整生命年68,500美元。一级预防的中位增量成本效益比最低，三级预防最高。
一级预防可能比二级和三级预防干预措施更具成本效益；然而，相比之下，尤其是行业对一级预防干预措施的研究投资滞后。这些发现有助于突出与五大主要死因相关的成本效益分析文献中的差距，并确定每种疾病研究不足的干预措施和预防阶段。
