Rubió P P
Public Health. 1997 Jan;111(1):33-40. doi: 10.1038/sj.ph.1900304.
Dietary treatment of hypercholesterolemia is one of the most frequently proposed measures to prevent cardiovascular disease. In this study cost-effectiveness of dietary treatment in Spain was assessed.
Cost-effectiveness ratio was measured in terms of cost per life years gained, comparing net programme cost to its effectiveness. Effectiveness was estimated using a model that incorporates the Framingham multiple logistic equation to obtain the number of coronary events prevented and life years gained according to age, sex and initial cholesterol concentration. In this study it was assumed that dietary treatment could reduce cholesterol concentration by 5% in the group of participants. Net programme cost was estimated as total programme cost less averted cardiovascular disease treatment costs due to disease prevention. Costs and benefits were estimated for 1990 using a 5% discount rate.
Cost per life year gained ranged from $6,270 to 61,439 in men and $28,067 to 171,459 in women, according to age and initial cholesterol concentration. The lowest cost-effectiveness ratio was obtained in individuals with a cholesterol concentration of 9.7 mmol/l (380 mg/dl) aged 45-49 years in men and 50-54 years in women, and the highest one was obtained in those men and women with a cholesterol concentration of 5.7 mmol/l (220 mg/dl) aged 60-65 years. Cost per life year gained was lower than $25,000 in men aged 35 to 64 years with a cholesterol concentration higher than 6.2 mmol/l (240 mg/dl) and it was lower than $35,000 in women aged 35 to 64 years with a cholesterol concentration higher than 9.3 mmol/l (360 mg/dl).
Individual dietary treatment of hypercholesterolemia could be considered an efficient use of health resources. Programme for dietary treatment of hypercholesterolemia should be recommended in men aged 35-64 years with hypercholesterolemia (> 6.2 mmol/l) and in women aged 35-64 years with very high cholesterol concentrations.
高胆固醇血症的饮食治疗是预防心血管疾病最常被提出的措施之一。本研究评估了西班牙饮食治疗的成本效益。
成本效益比以每获得一个生命年的成本来衡量，将项目净成本与其效果进行比较。使用一个纳入弗雷明汉多重逻辑方程的模型来估计效果，以根据年龄、性别和初始胆固醇浓度得出预防的冠心病事件数量和获得的生命年数。在本研究中，假设饮食治疗可使参与者组的胆固醇浓度降低5%。项目净成本估计为项目总成本减去因疾病预防而避免的心血管疾病治疗成本。使用5%的贴现率对1990年的成本和效益进行了估计。
根据年龄和初始胆固醇浓度，男性每获得一个生命年的成本在6270美元至61439美元之间，女性在28067美元至171459美元之间。在男性45 - 49岁、女性50 - 54岁且胆固醇浓度为9.7 mmol/l（380 mg/dl）的个体中获得最低成本效益比，而在胆固醇浓度为5.7 mmol/l（220 mg/dl）的60 - 65岁男性和女性中获得最高成本效益比。在胆固醇浓度高于6.2 mmol/l（240 mg/dl）的35至64岁男性中，每获得一个生命年的成本低于25000美元；在胆固醇浓度高于9.3 mmol/l（360 mg/dl）的35至64岁女性中，每获得一个生命年的成本低于35000美元。
高胆固醇血症的个体化饮食治疗可被视为对卫生资源的有效利用。对于胆固醇血症（> 6.2 mmol/l）的35 - 64岁男性和胆固醇浓度非常高的35 - 64岁女性，应推荐高胆固醇血症饮食治疗方案。
