SELECTION OF END-POINTS IN ECONOMIC EVALUATIONS OF CORONARY-HEART-DISEASE INTERVENTIONS

被引:22
作者
DRUMMOND, MF
HEYSE, J
COOK, J
MCGUIRE, A
机构
[1] MERCK SHARP & DOHME LTD,W POINT,PA 19486
[2] UNIV OXFORD,CTR SOCIOLEGAL STUDIES,OXFORD,ENGLAND
[3] CITY UNIV LONDON,LONDON EC1V 0HB,ENGLAND
关键词
ECONOMIC EVALUATION; COST EFFECTIVENESS ANALYSIS; COST UTILITY ANALYSIS; QUALITY OF LIFE; RISK ASSESSMENT MODEL; CORONARY HEART DISEASE; DRUG THERAPY;
D O I
10.1177/0272989X9301300303
中图分类号
R19 [保健组织与事业(卫生事业管理)];
学科分类号
摘要
Economic evaluations of interventions to lower blood pressure or cholesterol have used different outcome measures, or end points, in the denominator. Some have related the costs of interventions to improvements in physiologic end points such as mm Hg reduction in blood pressure. Some have related costs to avoidance of coronary heart disease (CHD) events or gains in life expectancy. Others have measured improvements in outcome in quality-adjusted life years (QALYs) gained. The different end points imply different analytic perspectives and different data requirements. The more ambitious analyses, though potentially more relevant in certain situations, require more controversial assumptions to be made. This paper illustrates the trade-offs of relevance, accuracy, and precision by reference to an evaluation of drug therapy for hypercholesterolemia undertaken in the United Kingdom. Estimates are given of cost per percentage cholesterol reduction, cost per CHD event avoided, cost per CHD-free year gained, cost per life year gained, and cost per quality-adjusted life year gained. In each case the assumptions required and the potential relevance of the estimate are discussed. The main findings are that: 1) some end points cannot be discounted to present values in a meaningful way and hence the timing of costs and outcomes cannot be reflected in the analysis; 2) the incorporation of quality-of-life adjustments for years on drug therapy and years post-CHD events greatly changes the cost-effectiveness ratios; 3) the rate of discount changes the pretreatment level of cholesterol for which cost per life year gained is equivalent to cost per quality-adjusted life year gained.
引用
收藏
页码:184 / 190
页数:7
相关论文
共 32 条
[1]  
ABBOTT RD, 1987, US DHEW NIH872703 PH
[2]  
BERWICK DM, 1981, PEDIATRICS, V68, P721
[3]  
BUXTON MR, 1985, COSTS BENEFITS HEART
[4]   THE EFFECTS OF ANTIHYPERTENSIVE THERAPY ON THE QUALITY-OF-LIFE [J].
CROOG, SH ;
LEVINE, S ;
TESTA, MA ;
BROWN, B ;
BULPITT, CJ ;
JENKINS, CD ;
KLERMAN, GL ;
WILLIAMS, GH .
NEW ENGLAND JOURNAL OF MEDICINE, 1986, 314 (26) :1657-1664
[5]  
Drummond M. F., 1987, METHODS EC EVALUATIO
[6]  
DRUMMOND MF, 1990, SOCIAL EC CONTEXTS C
[7]  
EDELSON JT, 1990, JAMA-J AM MED ASSOC, V263, P408
[8]  
FLETCHER A, 1989, UNPUB EPIDEMIOLOGY C
[9]  
GAFNI A, 1990, CAN MED ASSOC J, V143, P475
[10]   WILLINGNESS-TO-PAY AS A MEASURE OF BENEFITS - RELEVANT QUESTIONS IN THE CONTEXT OF PUBLIC DECISION-MAKING ABOUT HEALTH-CARE PROGRAMS [J].
GAFNI, A .
MEDICAL CARE, 1991, 29 (12) :1246-1252