新的CHD危险因素及评估方法PPT课件.pptVIP

Magnitude of the Burden—Causes of Death in the United States Economic Direct and Indirect Cost of CVD in the United States 5-Year Expected Total Cost per Case Preventive Medicine Costs Cost of preventive measures Treatment Testing Complications of preventive measures Treating cases that arise anyway Treating diseases discovered Treating other illnesses in population living longer Pay “up-front” for benefit later False positive Treating those who will not develop disease Cost-Effectiveness Analysis Purpose: Consider both the effectiveness and cost of an intervention Whose Costs Matter? Patient: The costs the patient bears directly (depends on co-payment) Insurance: Costs the insurance bears directly Societal: Includes all costs and avoids double counting Measuring Costs Direct Costs: Direct medical costs related to the diagnosis and treatment of the disease + disease-specific costs that may be induced or averted Indirect Costs: Lost earnings Other Costs: Prolonged life ??increased cancer, nursing home patients Premature events, disability payments, reduced productivity Cost-Effectiveness: Quality Adjusted Life Years General Guidelines Incremental Cost-Effectiveness (QALY) Cholesterol Lowering:Cost-Effectiveness Cost Effectiveness of Simvastatin Treatment for 5 Years in 59-Year-Old Patients with CHD and a Pretreatment Total Cholesterol Level of 261 mg/dl Cost Per Year of Life Gained in Patients with CHD Who Received Simvastatin Treatment for 5 Years WOSCOPS Placebo Group 5-Year Total Event Rates New Tests for Risk Assessment I. Lipoprotein assessment Lipoprotein(a)* Apoproteins: apo B-100,* A-I, CIII-B LDL particle size  Apo E genotype Lp(a) in Atherogenesis: Another Culprit? Identical to LDL particle except for addition of apo(a) Plasma concentration predictive of atherosclerotic disease in many, although not all, epidemiologic studies Accumulates in atherosclerotic plaque Binds apo B–containing lipoproteins and pro