Cost effectiveness analysis of a next generation risk assessment score for cardiovascular disease

Objectives:

The goal of this study is to determine the cost-effectiveness of MIRISK VP, a next generation coronary heart disease risk assessment score, in correctly reclassifying and appropriately treating asymptomatic, intermediate risk patients.

Study design:

A Markov model was employed with simulated subjects based on the Multi-Ethnic Study of Atherosclerosis (MESA). This study evaluated three treatment strategies: (i) practice at MESA enrollment, (ii) current guidelines, and (iii) MIRISK VP in MESA.

Methods:

The model assessed patient healthcare costs and outcomes, expressed in terms of life years and quality-adjusted life years (QALYs), over the lifetime of the cohort from the provider and payer perspective. A total of 50,000 hypothetical individuals were used in the model. A sensitivity analysis was conducted (based on the various input parameters) for the entire cohort and also for individuals aged 65 and older.

Results:

Guiding treatment with MIRISK VP leads to the highest net monetary benefits when compared to the ‘Practice at MESA Enrollment’ or to the ‘Current Guidelines’ strategies. MIRISK VP resulted in a lower mortality rate from any CHD event and a modest increase in QALY of 0.12–0.17 years compared to the other two approaches.

Limitations:

This study has limitations of not comparing performance against strategies other than the FRS, the results are simulated as with all models, the model does not incorporate indirect healthcare costs, and the impact of patient or physician behaviors on outcomes were not taken into account.

Conclusions:

MIRISK VP has the potential to improve patient outcomes compared to the alternative strategies. It is marginally more costly than both the ‘Practice at MESA Enrollment’ and the ‘Current Guidelines’ strategies, but it provides increased effectiveness, which leads to positive net monetary benefits over either strategy.     

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汉语"把字句"基于最简方案的思考

从乔姆斯基的最简方案入手,分析现代汉语中的“把字句”的主要特征,试图把“把字句”的研究与其他相关句式的研究结合起来而取得研究的统一性。汉语“把”具有相同的最大投射,即Larson提出的动词短语嵌套。汉语中的“把字句”研究只有和其他的相关句式结合起来,才能真正地对“把字句”的方方面面的疑难问题有所交代。     

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政协提案管理系统是利用计算机及网络技术加强政协提案管理工作的辅助工具。文章主要针对地方政协提案管理工作的实际和发展趋势,阐述了如何通过计算机网络为政协委员在提案提交、查询方面,为相关部门在提案交办、管理等方面提供信息化辅助手段,塑造一种全新的提案管理模式,提高整体提案管理水平。     

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