新的CHD危险因素及评估方法PPT课件.ppt

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1、MagnitudeoftheBurden—CausesofDeathintheUnitedStatesDeathsin1996(thousands)CVDCancerAccidentsHIV/AIDS959.2544.793.832.7AmericanHeartAssociation.1999HeartandStrokeStatisticalUpdate.1998.EconomicDirectandIndirectCostofCVDintheUnitedStatesHospital/nursinghomePhysicians/oth

2、erprofessionalsDrugsHomehealth/othermedicaldurablesLostproductivity/morbidityLostproductivity/mortalityAmericanHeartAssociation.1999HeartandStrokeStatisticalUpdate.1998.Totaldirectandindirectcosts:$286.5billion5-YearExpectedTotalCostperCaseWittelsEHetal.AmJCardiol1990;

3、65:432–440.AverageCost(1986$)CHDeventsAcutemyocardialinfarction51,211Anginapectoris24,980Unstableanginapectoris40,581Suddendeath9,078ProceduresAngioplasty26,916Bypasssurgery32,465PreventiveMedicineCostsCostofpreventivemeasuresTreatmentTestingComplicationsofpreventiveme

4、asuresTreatingcasesthatariseanywayTreatingdiseasesdiscoveredTreatingotherillnessesinpopulationlivinglongerPay“up-front”forbenefitlaterFalsepositiveTreatingthosewhowillnotdevelopdiseaseCost-EffectivenessAnalysisPurpose:Considerboththeeffectivenessandcostofanintervention

5、Cost=Costofmedicalintervention+costofillnessEffectiveness=qualityadjustedlifeyearsavedCE=Cost-effectivenessratioCE2-1=Cost2–Cost1QALY2–QALY1WhoseCostsMatter?Patient:Thecoststhepatientbearsdirectly(dependsonco-payment)Insurance:CoststheinsurancebearsdirectlySocietal:Inc

6、ludesallcostsandavoidsdoublecountingMeasuringCostsDirectCosts:Directmedicalcostsrelatedtothediagnosisandtreatmentofthedisease+disease-specificcoststhatmaybeinducedoravertedIndirectCosts:LostearningsOtherCosts:Prolongedlifeincreasedcancer,nursinghomepatientsPrematuree

7、vents,disabilitypayments,reducedproductivityCost-Effectiveness:QualityAdjustedLifeYearsMildhypertensionmaleage40$23,300EstrogentherapypostmenopausalSx$32,900Neonatalintensivecare$38,800Schooltuberculosistesting$53,300Hospitalhemodialysis$65,900GeneralGuidelinesIncreme

8、ntalCost-Effectiveness(QALY)GoldmanLetal.Circulation1992;85:1960–1968.0–$20,000Veryattractive$20,000–$40,000Currently