| アブストラクト | OBJECTIVES: To determine the cost-effectiveness of two bespoke severe mental illness (SMI)-specific risk algorithms compared with standard risk algorithms for primary cardiovascular disease (CVD) prevention in those with SMI. SETTING: Primary care setting in the UK. The analysis was from the National Health Service perspective. PARTICIPANTS: 1000 individuals with SMI from The Health Improvement Network Database, aged 30-74 years and without existing CVD, populated the model. INTERVENTIONS: Four cardiovascular risk algorithms were assessed: (1) general population lipid, (2) general population body mass index (BMI), (3) SMI-specific lipid and (4) SMI-specific BMI, compared against no algorithm. At baseline, each cardiovascular risk algorithm was applied and those considered high risk (> 10%) were assumed to be prescribed statin therapy while others received usual care. PRIMARY AND SECONDARY OUTCOME MEASURES: Quality-adjusted life years (QALYs) and costs were accrued for each algorithm including no algorithm, and cost-effectiveness was calculated using the net monetary benefit (NMB) approach. Deterministic and probabilistic sensitivity analyses were performed to test assumptions made and uncertainty around parameter estimates. RESULTS: The SMI-specific BMI algorithm had the highest NMB resulting in 15 additional QALYs and a cost saving of approximately pound53 000 per 1000 patients with SMI over 10 years, followed by the general population lipid algorithm (13 additional QALYs and a cost saving of pound46 000). CONCLUSIONS: The general population lipid and SMI-specific BMI algorithms performed equally well. The ease and acceptability of use of an SMI-specific BMI algorithm (blood tests not required) makes it an attractive algorithm to implement in clinical settings. |
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| ジャーナル名 | BMJ open |
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| Pubmed追加日 | 2017/9/8 |
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| 投稿者 | Zomer, Ella; Osborn, David; Nazareth, Irwin; Blackburn, Ruth; Burton, Alexandra; Hardoon, Sarah; Holt, Richard Ian Gregory; King, Michael; Marston, Louise; Morris, Stephen; Omar, Rumana; Petersen, Irene; Walters, Kate; Hunter, Rachael Maree |
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| 組織名 | Department of Epidemiology and Preventive Medicine, Faculty of Medicine, Nursing;and Health Sciences, Monash University, Melbourne, Australia.;Department of Primary Care and Population Health, Faculty of Population Health;Sciences, University College London, London, UK.;Division of Psychiatry, Faculty of Brain Sciences, University College London,;London, UK.;Camden and Islington National Health Service Foundation Trust, London, UK.;Human Development and Health Academic Unit, Faculty of Medicine, University of;Southampton, Southampton, UK.;Department of Applied Health Research, Faculty of Population Health Sciences,;University College London, London, UK.;Department of Statistical Science, Faculty of Mathematical and Physical Sciences, |
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| Pubmed リンク | https://www.ncbi.nlm.nih.gov/pubmed/28877952/ |
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