Targeted versus universal prevention. a resource allocation model to prioritize cardiovascular prevention

Cost Effectiveness and Resource Allocation

Research

Monique AM Jacobs-van der Bruggen¹  Talitha L Feenstra²  Caroline A Baan³  Pieter M van Baal⁴  Geert-Jan Kommer⁵  Rudolf T Hoogenveen⁶ 

[1] Centre for Prevention and Health Services Research, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands;Centre for Prevention and Health Services Research, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands;Department of Epidemiology, University Medical Centre Groningen, Groningen, the Netherlands;Centre for Prevention and Health Services Research, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands;EMGO Institute for Health and Care Research, VU University Amsterdam, Amsterdam, the Netherlands;Centre for Prevention and Health Services Research, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands;Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, the Netherlands;Centre for Public Health Forecasting, RIVM, Bilthoven, the Netherlands;Expertise Centre for Methodology and Information Services, RIVM, Bilthoven, The Netherlands;

关键词: Diabetes Patient;    Optimal Allocation;    Capacity Constraint;    Efficiency Frontier;    Mathematical Programming Model;   

DOI  :  10.1186/1478-7547-9-14

 received in 2010-11-18, accepted in 2011-10-06,  发布年份 2011

来源: Springer

【 摘 要 】

BackgroundDiabetes mellitus brings an increased risk for cardiovascular complications and patients profit from prevention. This prevention also suits the general population. The question arises what is a better strategy: target the general population or diabetes patients.MethodsA mathematical programming model was developed to calculate optimal allocations for the Dutch population of the following interventions: smoking cessation support, diet and exercise to reduce overweight, statins, and medication to reduce blood pressure. Outcomes were total lifetime health care costs and QALYs. Budget sizes were varied and the division of resources between the general population and diabetes patients was assessed.ResultsFull implementation of all interventions resulted in a gain of 560,000 QALY at a cost of €640 per capita, about €12,900 per QALY on average. The large majority of these QALY gains could be obtained at incremental costs below €20,000 per QALY. Low or high budgets (below €9 or above €100 per capita) were predominantly spent in the general population. Moderate budgets were mostly spent in diabetes patients.ConclusionsMajor health gains can be realized efficiently by offering prevention to both the general and the diabetic population. However, a priori setting a specific distribution of resources is suboptimal. Resource allocation models allow accounting for capacity constraints and program size in addition to efficiency.

【 授权许可】

CC BY   
© Feenstra et al; licensee BioMed Central Ltd. 2011