Tosteson A N, Weinstein M C, Hunink M G, Mittleman M A, Williams L W, Goldman P A, Goldman L
Department of Medicine, Dartmouth Medical School, Hanover, NH, USA.
Circulation. 1997 Jan 7;95(1):24-30. doi: 10.1161/01.cir.95.1.24.
The aim of the present study was to estimate the cost-effectiveness of populationwide approaches to reduce serum cholesterol levels in the US adult population.
This cost-effectiveness analysis was made from data from the literature and the Coronary Heart Disease Policy Model and was based on the US population age 35 to 84 years. Study interventions were populationwide programs to reduce serum cholesterol levels with costs and cholesterol-lowering effects similar to those reported from the Stanford Three-Community Study, the Stanford Five-City Project, and in North Karelia, Finland. The main outcome measures were cost-effectiveness ratios, defined as the change in projected cost divided by the change in projected life-years when the population receives the intervention compared with the population without the intervention. A populationwide program with the costs ($4.95 per person per year) and cholesterol-lowering effects (an average 2% reduction in serum cholesterol levels) of the Stanford Five-City Project would prolong life at an estimated cost of only $3200 per year of life saved. Under a wide variety of assumptions, a populationwide program would achieve health benefits at a cost equivalent to that of many currently accepted medical interventions. Such programs would also lengthen life and save resources under many scenarios, especially if the program affected persons with preexisting heart disease or altered other coronary risk factors.
Populationwide programs should be part of any national health strategy to reduce coronary heart disease.
本研究的目的是评估在美国成年人群中采用全人群方法降低血清胆固醇水平的成本效益。
本成本效益分析基于文献数据和冠心病政策模型，以35至84岁的美国人群为基础。研究干预措施是全人群项目，旨在降低血清胆固醇水平，其成本和降胆固醇效果与斯坦福三社区研究、斯坦福五城市项目以及芬兰北卡累利阿地区报告的类似。主要结局指标是成本效益比，定义为当人群接受干预时与未接受干预的人群相比，预计成本的变化除以预计生命年数的变化。一个具有斯坦福五城市项目成本（每人每年4.95美元）和降胆固醇效果（血清胆固醇水平平均降低2%）的全人群项目，每挽救一年生命的估计成本仅为3200美元。在各种假设下，全人群项目将以与许多当前被接受的医学干预相当的成本实现健康效益。在许多情况下，此类项目还将延长寿命并节省资源，特别是如果该项目影响已有心脏病的人群或改变其他冠心病危险因素。
全人群项目应成为任何国家降低冠心病健康战略的一部分。
