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Circulation:他汀类使用指南对冠心病和卒中初级预防的影响和成本效益评估

2017-07-09 xiangting MedSci原创

在人群层面上与ATP III相比,不论男女ACC-AHA指南为初级预防扩大他汀类使用将会治疗更多的人,挽救更多的生命,并节省成本。

他汀类在动脉粥样硬化性心血管疾病的初级预防中是有效的。2013年美国心脏病学会/美国心脏协会(ACC-AHA)指南扩大了他汀类的推荐使用,但其成本效益尚未与其他指南进行比较。

研究人员使用心血管疾病(CVD)政策模型估计2016年到2025年的10年间ACC-AHA,成人治疗组III(ATP III)指南,和45-74岁男性及55-74岁女性普遍使用他汀类药物的成本效益。灵敏度分析不同的成本、风险和收益。主要结局是增加的成本效益比(ICER)和每质量调整生命年需要的治疗十年的数目(NNT / QALY)。

与现状相比,每种方式都产生实质性益处和净成本节省。完全按照ATP III指南将产生比现在更多的880万他汀类药物使用者,NNT / QALY为35. ACC-AHA指南比ATP III指南可能会产生额外的1,230万他汀类使用者,其中NNT/QALY为68。所有45-74岁男性和55-74岁女性中等强度的他汀使用将比ACC-AHA指南多产生2890万他汀类使用者,其NNT/QALY为108。在所有情况下,男性的获益大于女性。结果随他汀类使用和他汀类毒性估计风险阈值不同而不同,但很大程度上取决于日常用药所引起的不适(药物负担)。

在人群层面上与ATP III相比,不论男女ACC-AHA指南为初级预防扩大他汀类使用将会治疗更多的人,挽救更多的生命,并节省成本。个体是否会在初级预防中长期使用他汀类药物而受益,更多地取决于与药物负担相关的不适,而不是其心血管风险程度。

原始出处:

David J. Heller,et al. Evaluating the Impact and Cost-Effectiveness of Statin Use Guidelines for Primary Prevention of Coronary Heart Disease and Stroke. Circulation. 7 July 2017.

本文系梅斯医学(MedSci)原创编译整理,转载需授权!

 

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  1. [GetPortalCommentsPageByObjectIdResponse(id=1359853, encodeId=2fa3135985322, content=<a href='/topic/show?id=8efa5402320' target=_blank style='color:#2F92EE;'>#成本效益#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54023, encryptionId=8efa5402320, topicName=成本效益)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Tue Jul 11 01:59:00 CST 2017, time=2017-07-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=220408, encodeId=8bbb22040876, content=他汀有作用,但是作用有多大?NNT / QALY为35,还可以, beContent=null, objectType=article, channel=null, level=null, likeNumber=92, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c4a5105539, createdName=lovetcm, createdTime=Sun Jul 09 21:25:01 CST 2017, time=2017-07-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=220290, encodeId=48c422029056, content=学习一下知识了, beContent=null, objectType=article, channel=null, level=null, likeNumber=101, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160718/IMG578C993D395567540.jpg, createdBy=59b81918946, createdName=flysky120, createdTime=Sun Jul 09 11:16:04 CST 2017, time=2017-07-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=220289, encodeId=6a92220289ef, content=好的,学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=90, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ad4c106013, createdName=Drhzm308, createdTime=Sun Jul 09 11:13:40 CST 2017, time=2017-07-09, status=1, ipAttribution=)]
  2. [GetPortalCommentsPageByObjectIdResponse(id=1359853, encodeId=2fa3135985322, content=<a href='/topic/show?id=8efa5402320' target=_blank style='color:#2F92EE;'>#成本效益#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54023, encryptionId=8efa5402320, topicName=成本效益)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Tue Jul 11 01:59:00 CST 2017, time=2017-07-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=220408, encodeId=8bbb22040876, content=他汀有作用,但是作用有多大?NNT / QALY为35,还可以, beContent=null, objectType=article, channel=null, level=null, likeNumber=92, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c4a5105539, createdName=lovetcm, createdTime=Sun Jul 09 21:25:01 CST 2017, time=2017-07-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=220290, encodeId=48c422029056, content=学习一下知识了, beContent=null, objectType=article, channel=null, level=null, likeNumber=101, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160718/IMG578C993D395567540.jpg, createdBy=59b81918946, createdName=flysky120, createdTime=Sun Jul 09 11:16:04 CST 2017, time=2017-07-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=220289, encodeId=6a92220289ef, content=好的,学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=90, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ad4c106013, createdName=Drhzm308, createdTime=Sun Jul 09 11:13:40 CST 2017, time=2017-07-09, status=1, ipAttribution=)]
    2017-07-09 lovetcm

    他汀有作用,但是作用有多大?NNT / QALY为35,还可以

    0

  3. [GetPortalCommentsPageByObjectIdResponse(id=1359853, encodeId=2fa3135985322, content=<a href='/topic/show?id=8efa5402320' target=_blank style='color:#2F92EE;'>#成本效益#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54023, encryptionId=8efa5402320, topicName=成本效益)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Tue Jul 11 01:59:00 CST 2017, time=2017-07-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=220408, encodeId=8bbb22040876, content=他汀有作用,但是作用有多大?NNT / QALY为35,还可以, beContent=null, objectType=article, channel=null, level=null, likeNumber=92, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c4a5105539, createdName=lovetcm, createdTime=Sun Jul 09 21:25:01 CST 2017, time=2017-07-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=220290, encodeId=48c422029056, content=学习一下知识了, beContent=null, objectType=article, channel=null, level=null, likeNumber=101, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160718/IMG578C993D395567540.jpg, createdBy=59b81918946, createdName=flysky120, createdTime=Sun Jul 09 11:16:04 CST 2017, time=2017-07-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=220289, encodeId=6a92220289ef, content=好的,学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=90, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ad4c106013, createdName=Drhzm308, createdTime=Sun Jul 09 11:13:40 CST 2017, time=2017-07-09, status=1, ipAttribution=)]
    2017-07-09 flysky120

    学习一下知识了

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=1359853, encodeId=2fa3135985322, content=<a href='/topic/show?id=8efa5402320' target=_blank style='color:#2F92EE;'>#成本效益#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54023, encryptionId=8efa5402320, topicName=成本效益)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Tue Jul 11 01:59:00 CST 2017, time=2017-07-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=220408, encodeId=8bbb22040876, content=他汀有作用,但是作用有多大?NNT / QALY为35,还可以, beContent=null, objectType=article, channel=null, level=null, likeNumber=92, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c4a5105539, createdName=lovetcm, createdTime=Sun Jul 09 21:25:01 CST 2017, time=2017-07-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=220290, encodeId=48c422029056, content=学习一下知识了, beContent=null, objectType=article, channel=null, level=null, likeNumber=101, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160718/IMG578C993D395567540.jpg, createdBy=59b81918946, createdName=flysky120, createdTime=Sun Jul 09 11:16:04 CST 2017, time=2017-07-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=220289, encodeId=6a92220289ef, content=好的,学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=90, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ad4c106013, createdName=Drhzm308, createdTime=Sun Jul 09 11:13:40 CST 2017, time=2017-07-09, status=1, ipAttribution=)]
    2017-07-09 Drhzm308

    好的,学习了

    0

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