Cucherat M, Boissel J P
Université Claude Bernard Lyon, Hospices Civils de Lyon, France.
Eur J Epidemiol. 1998 Jan;14(1):23-9. doi: 10.1023/a:1007423730270.
Hypercholesterolemia or hypertension are continuous risk factors for coronary heart disease. When a preventive action is carried out against such a risk factor, it is necessary to specify a risk factor level value, named the treatment threshold, above which a subject should be treated. But a non-arbitrary determination of this threshold value is impossible from the epidemiological data. A method for the non-arbitrary determination of the treatment threshold value is presented, based upon mathematical modelling of the clinical and economics consequences of the prevention policy in the whole population. In a cost-effectiveness approach, the model was used to estimate the cost per coronary event prevented according to the threshold value for blood cholesterol. It was found that a minimum in this outcome proposed as the optimum treatment threshold. It is possible, from a public health point of view, to determine an optimum, non-arbitrary treatment threshold value in the prevention of coronary heart disease with cholesterol-lowering interventions. The model proposed here could be useful in decision making processes.
高胆固醇血症或高血压是冠心病的持续风险因素。当针对此类风险因素采取预防措施时，有必要指定一个风险因素水平值，即治疗阈值，高于该值的个体应接受治疗。但从流行病学数据中无法非任意地确定此阈值。本文提出了一种非任意确定治疗阈值的方法，该方法基于对整个人群预防策略的临床和经济后果进行数学建模。在成本效益分析方法中，该模型用于根据血胆固醇阈值估计预防每例冠心病事件的成本。结果发现，该结果中的最小值可作为最佳治疗阈值。从公共卫生角度来看，在通过降低胆固醇干预预防冠心病时，有可能确定一个最佳的、非任意的治疗阈值。本文提出的模型在决策过程中可能会有所帮助。
