targeted versus universal prevention. a resource allocation model to prioritize cardiovascular prevention有针对性的和普遍的预防。.pdfVIP

Feenstra et al. Cost Effectiveness and Resource Allocation 2011, 9:14 /content/9/1/14 RESEARCH Open Access Targeted versus universal prevention. a resource allocation model to prioritize cardiovascular prevention 1,2* 1,3 1 4 Talitha L Feenstra , Pieter M van Baal , Monique AM Jacobs-van der Bruggen , Rudolf T Hoogenveen , Geert-Jan Kommer5 and Caroline A Baan1,6 Abstract Background: Diabetes 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. Methods: A 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. Results: Full 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. Conclusions: Major 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